Regional Clinical Reimbursement Consultant
at Guardian Elder Care

Date Posted: 4/9/2018

Job Description

Guardian Elder Care is a growing family of skilled nursing facilities committed to providing the highest quality of care and service to our residents.   Guided by our mission and legacy values, we are relentlessly driven to achieve the best outcomes for those whom we serve. 

We are excited to announce the opening of a Regional Consultant position in our Clinical Reimbursement Department.  This position reports directly to the Executive Director of Clinical Reimbursement and Case Management and contributes to the success of the region and company as a self-motivating professional who strives to improve overall performance.

The Regional Clinical Reimbursement Consultant is primarily responsible for ensuring federal and state compliance with the RAI process.  Other responsibilities include, but are not limited to:

  • Travel between multiple facilities
  • Function as the regional team subject matter expert on the RAI, Medicare, Medicaid, and Managed Care processes
  • Training for and oversight of RNACs on the compliant and accurate management of the RAI, Medicare, Medicaid, and Managed Care processes
  • Training for Facility Administration and staff, as needed, on the compliant and accurate completion of the RAI, Medicare, Medicaid, and Managed Care processes
  • Auditing and integrity monitoring of:
    • Overall RAI process
    • Medicare, Medicaid, and Managed Care program requirements
    • Medicare and Managed Care rates
    • Medicaid Case Mix
    • ADL Coding Accuracy
    • RUG Trends
  • Review and analysis of QM reports to investigate trends and assist facility staff in development and completion of improvement plans
  • Assist in processing of Medical Record requests with positive results
  • Facility support in recruitment and retention of MDS Department staff
    • Second level interviewing
    • Assist with orientation and ongoing training
    • Report progress and recommendations to facility Administrator
  • Collaboration with Clinical Reimbursement Services Department in development of programs and training
  • Corporate Regional Meeting/Activities participation



Job Requirements

  • Current RN license by State Board of Nursing
  • Minimum 4 years experience in Clinical Reimbursement in a long-term care setting
  • Prior multi-facility management experience strongly preferred
  • Excellent communicator and educator
  • Computer skills necessary
  • Positive attitude and an insatiable drive for excellence.
  • Current RN license by State Board of Nursing
  • Minimum 4 years experience in Clinical Reimbursement in a long-term care setting
  • Prior multi-facility management experience strongly preferred
  • Excellent communicator and educator
  • Computer skills necessary
  • Positive attitude and an insatiable drive for excellence.

Guardian is willing to offer the following to the preferred candidate:

  • Executive level pay
  • Generous Benefit package that includes vacation, sick, 401(k) with employer match, health, vision, dental, FSA, etc….
  • Opportunity to work for a large, stable long-term care organization with small company values
  • Mentoring/guidance from Clinical Reimbursement Services Department to assure success in role



EOE


Job Snapshot

About Us

As Guardian grows, we look for quality people who can identify with our philosophy and goals. We are looking for KEEPERS. What are KEEPERS? "KEEPERS" is what makes the staff of Guardian Elder Care a powerful force in the healthcare industry.

As Guardian continues to grow and expand, we are looking for special people to join our team: people who will embrace our unparalleled OnGuard culture.Every day. In every interaction. With every patient. With every co-worker. For this culture is what truly sets us apart.

The OnGuard culture is our company’s overarching philosophy to create the optimal experience for every person who enters one of our facilities. OnGuard uniquely empowers each employee to care deeply. This level of caring means acting quickly on the resident or family member’s behalf without having to ask permission; giving of oneself in a way that warms, heals, calms, delights; being ready with a solution to any problem that arises; and joyfully going that extra mile. With OnGuard, you never have to ask permission to care; it is inherent in your role as one of our valued team members.

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