Director Of Clinical Reimbursement

Overview

• Lead the Clinical Documentation and Reimbursement department, ensuring compliance with operational and regulatory requirements.
• Develop strategic plans for Medicare/Medicaid reimbursement and Managed Care Case Management.
• Collaborate with department heads to enhance care quality through clinical documentation.
• Monitor and implement education plans related to MDS updates and payment reforms.
• Analyze and track MDS data to support quality assurance initiatives.
• Audit and oversee RAI processes to ensure compliance with NYS DOH regulations.
• Supervise MDS and HIM staff, fostering professional development and performance excellence.
• Contribute to organizational success through effective leadership and strategic planning.

Key Responsibilities & Duties

• Collaborate with teams to utilize clinical documentation for quality care improvement.
• Lead strategic planning for reimbursement processes and case management.
• Develop and implement facility-wide education plans for MDS updates.
• Analyze MDS data to support quality assurance and performance improvement.
• Audit RAI processes to ensure compliance with regulatory standards.
• Provide oversight and supervision to MDS and HIM staff.
• Ensure adherence to Federal and State regulations and nursing standards.
• Communicate effectively across organizational levels and with diverse stakeholders.

Job Requirements

• Bachelor’s Degree in Nursing required; Master’s Degree preferred.
• Active NYS RN license with experience in RAI process and SNF reimbursement.
• Completion of New York State approved PRI assessor program preferred.
• RAC-CT certification preferred.
• Knowledge of Federal and State regulations and NYS nursing standards.
• Experience with Medicaid and Medicare regulations and SNF-based quality metrics.
• Strong analytical and project management skills.
• Effective communication and interpersonal skills, with ability to lead teams.