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.