SVP - Senior Vice President Clinical Reimbursement
Location: Louisville, Kentucky
Type: Full Time
Hospital, Public and Private
Internal Number: SVPCR
We’re currently hiring for the position of Senior Vice President of Clinical Reimbursement to join our Operations team reporting to our COO. We are seeking a Registered Nurse in good standing with the required license for each state in which consulting, a minimum of 5 years experience leading a clinical reimbursement team and RAI/MDS, PPS, Medicare, Medicaid and Managed Care experience required.
How you will make a difference • Assist with systems development and implementation of programs that apply to the Resident Assessment Instrument (RAI), Prospective Payment Systems (PPS), Quality Measures (QM’s), Medicaid Casemix and Medicare/Medicaid guidelines for all SHC Stakeholders. How you will spend your time • Meet physical and sensory requirements stated below, and be able to work in the described environment. • Identify and participate in performance and process improvement initiatives that improve the customer experience, enhance work flow, and/or improve the work environment. • Assist with design and presentation of RAI, PPS, Quality Measures, Medicare and Medicare education utilizing various types of media, technology, workshops, classes, and one on one. • Instruct clinical staff on linking assessment with reimbursement, patient care plan, delivery and outcome of care. • Demonstrate, educate and share sound fundamental knowledge of the RAI/MDS/PPS process. • Work with Facility Therapists and MDS Coordinators to ensure appropriate establishment of Assessment Reference Dates (ARDs) and MDS scheduling. • Participate in follow-up and evaluation of the entire RAI/MDS/PPS process. • Assist facility staff to use RAI/MDS/PPS data used for process improvement. • Assist with selection, application, and evaluation of MDS Coordinators. • Assist with design and evaluation/re-evaluation of MDS Coordinator orientation and follow-up programs. • Participate on assigned Facility Advisory Board (FAB) as regional representative, as required. • Evaluate efficacy of patient care plans and link with physical and functional assessment. • Work closely with other clinical disciplines to develop state-of-the-art methods to improve MDS accuracy overall. • Assist facility staff with plans of action to resolve variances in assessment and reimbursement data. • Collaborate with other departments and clinical field staff regarding RAI/MDS/PPS status and issues. • Identify specific areas to improve the RAI/MDS/PPS process and participate in process improvement. • Conduct facility site visits to orient new MDS Coordinators as well as to evaluate and reinforce RAI/MDS/PPS processes. • Interface with business office staff regarding Medicare/Medicaid claims and MDS process.
The qualifications you will need • Currently registered in state employed. • Minimum of five (5) years related experience as a licensed Registered Nurse in a long term care setting. • Effective verbal and written English communication skills. • Demonstrated intermediate to advanced skills in Microsoft Word, Excel, Power Point and Outlook, Internet and Intranet navigation. • Highest level of professionalism with the ability to maintain confidentiality. • Ability to communicate at all levels of organization and work well within a team environment in support of company objectives. • Customer service oriented with the ability to work well under pressure. • Strong attention to detail and accuracy, excellent organizational skills with ability to prioritize, coordinate and simultaneously maintain multiple projects with high level of quality and productivity. • Strong analytical and problem solving skills. • Ability to work with minimal supervision, take initiative and make independent decisions. • Ability to deal with new tasks without the benefit of written procedures. • Routine travel to multiple sites, including occasional overnight stays. • Function independently, and have flexibility, personal integrity, and the ability to work effectively with stakeholders and vendors.
Signature HealthCARE is a family-based healthcare company that offers integrated services in 8 states across the continuum of care: skilled nursing, rehabilitation, assisted living, memory care, cognitive care, and telemedicine. A growing number of our centers are earning quality assurance accreditation and pioneering person – directed care. Many of our skilled nursing facilities have achieved a 4 or 5-star overall rating from the Centers for Medicare Medicaid Services. Additionally, we have been awarded as a certified Great Place to Work for three years in a row and Modern Healthcare’s “Best Places to Work!”
Are you looking for a little more creativity, challenge, and growth opportunity in your workday? Didn’t think it was possible? Might be time to reconsider.
At Signature HealthCARE, our team members are permitted – no, encouraged – to employ their talents and abilities to solve problems. Our culture is built on three distinct pillars: Learning, Spirituality and Intra-preneurship. But this isn’t just hollow corporate sloganeering. Each pillar has its own staff and initiatives, ensuring that our unique culture permeates the entire organization.
Oh, by the way, we’re an elder care company. Our mission? To radically change the landscape of long-term care forever.
To improve the patient experience by providing health care providers; patients and their families; and others with information, education, networking opportunities, and related resources focused on best practices.