RN / LPN Manager Clinical Reimbursement Job Location: Wallingford Center, Connecticut RN / LPN Manager Clinical Reimbursement Masonicare Health Center - Wallingford, CT Day Shift / 40hrs/wk The Manager Clinical Reimbursement is responsible for coordinating, managing and ensuring the accuracy/capitalization of the facility’s reimbursement from its payor sources. Responsible for the coordination of the Resident Assessment Instrument (RAI) process. Essential Duties and Responsibilities: + Manages the facility’s RAI processes to capture accurate resident related data as well as work with all resident service department s involved in the RAI process to maximize resident’s full reimbursement potential. + Provides/ensures accurate documentation of all services in order to maximize accurate reimbursement from all payor sources. + Completes all performance reviews with staff along with hiring of new staff. + Selects, trains/orients and assigned department staff. Develops standards of performance, evaluates performance, and initiates or makes staff recommendations. + Reviews facility quality indicators, assisting as needed with identifying strengths and weaknesses of data and how it relates to facility care practices + Manages the patient’s Medicare benefit by communication of skilled needs to the patient, family and interdisciplinary care team. + Organize and participate in the daily Medicare meeting, utilization review and monthly end of close meetings. + Assists with Medicare denial claims/reviews when need is identified by billing office. + Keeps abreast of changes in the Medicare, Medicaid and managed care areans and MDS/RAI processes through journal reading, outside in-services an other sources. + Continually upgrades and makes changes in job area to assure that departments meet the needs to the changing market, federal and/or state mandates. + Participates in and attends all mandatory Masonicare in services and departmental staff and inservice meetings. Education: Requires a Registered Nurse or Licensed Practical Nurse with a current Connecticut State license and a BSN or MSN graduate degree from an accredited school of nursing preferred. Experience: Requires at least 3-5 years experience in geriatric nursing; Requires at least two (2) years experience with federal Medicare/Medicaid and Managed Care reimbursement systems with a thorough working knowledge of the MDS and RAI process; Requires a working knowledge of OBRA regulations as they relate to Skilled Nursing facilities; Requires strong working knowledge of statistics, data collection, analysis and presentation. Certificates, Licenses, Registrations: Current Connecticut State RN or LPN licensure required. #joinourteam Job ID: 13780 Share this Job Share this job with your friends and connections. + Facebook + X + LinkedIn + Email Job Alerts Email Address Areas of Interest Search for a category, location, or category/location pair, select a term from the suggestions, and click "Add". Category Location Add + Professionals, Wallingford Center, Connecticut, United States Remove + Remove Confirm Email Submit Submit Resume and Cover Letter Useful Links + Masonicare Website (http://www.masonicare.org/) + Why Masonicare + Mystic Community + Job Fairs + Hospice + Behavioral Health Similar Jobs + RN Behavioral Health Nurse (DAY SHIFT) Wallingford Center, Connecticut + RN Behavioral Health Nurse (EVENING SHIFT) Wallingford Center, Connecticut + RN Nursing Supervisor (NIGHT SHIFT) Wallingford Center, Connecticut Job Matching With just one click and a connection to LinkedIn we can find jobs for you that best match you work experience. 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