Job title: Regional Clinical Reimbursement Specialist – Full-Time
Company: North Shore Healthcare
Job description: Job Description:#LI-AS1dRegional Clinical Reimbursement Specialist (RN) – Skilled Nursing FacilitiesRequires travel to Milwaukee, Green Bay, WI Dells and others in betweenTrust, engagement, competence, respect and passion – these are the values under which North Shore Healthcare operates every day. Our dedicated team of professionals strive to deliver quality care to our residents and their families. We are one of the leading employers and providers of post-acute care in the Midwest and we are seeking exceptional individuals to join our team. If you value being a leader, working in a progressive environment and having opportunities to grow in your career, North Shore Healthcare is the Right Choice for you.Summary:The Regional Clinical Reimbursement Specialist will collaborate with the Regional Vice Presidents of Success, facility Administrators, MDS Coordinators and Directors of Nursing to ensure excellent survey outcomes and exceptional quality of care for the residents we serve.Regional Clinical Reimbursement Specialist provides support, education, and training to the MDS Coordinators in the facilities on the Resident Assessment Instrument (RAI) process in accordance with the laws, regulation, and company standards. Reviews and coordinates PDPM and Case Mix data for the region to ensure appropriate reimbursement.Job Requirements:
- Current license as a Registered Nurse issued by the State Board of Nursing (WI/ MN / ND /MI)
- Bachelor’s degree or Associate degree in nursing from accredited college
- Minimum 3 + years’ experience with the RAI process
- Prior multi-facility experience a plus
- Strong Knowledge of PDPM and State Case Mix Reimbursement payment models.
- Knowledgeable of nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to long-term care.
- Effective verbal and written communication skills.
- Ability to communicate at all levels of the 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.
- Ability to work with minimal supervision, take initiative and make independent decisions.
- Approachable, flexible, and adaptable to change.
- Function independently, and have flexibility, personal integrity, and the ability to work effectively with employees and vendors.
- Demonstrate basic to intermediate skills in Microsoft Word, Excel, Power Point, and Internet navigation, preferred.
- High level of professionalism with the ability to maintain confidentiality.
- Ability to travel.
Responsibilities:
- Provides leadership, oversight and acts as a resource for regional and facility staff specific to the RAI process, the Medicare program, and Medicaid Case Mix as applicable.
- Conducts regular monitoring of facility Medicare and Case Mix management.
- Works in coordination with the Regional Clinical Operations team to provide regional and facility interdisciplinary (IDT) teams with education and support for the development of systems to address and manage Quality Measures (QM) and the CMS Five Star Rating.
- Supports accurate claims and billing.
- Leads and participates in program improvement and development efforts related to the RAI, Medicare and Medicaid programs.
- Conducts follow-up evaluations to validate those systems are functioning well after initial roll-out.
- Participates in the Quality Assurance Process Improvement Program:
- Identifies and evaluates trends
- Assists with Root Cause Analysis
- Assists in identifying appropriate solutions
- Supports facility follow-up through appropriate measurement design
- Participates during “mock survey” process related to RAI with Regional Team as requested, and preparation for state and federal surveys as assigned.
Benefits:We offer a comprehensive benefit packages which includes:
- Health insurance for full-time employees starting the first of the month following 30 days of employment
- Dental and vision insurance for full and part-time staff
- 401(K) Program for full and part-time staff
- 6 paid holidays plus one floating holiday for full-time staff
- Company paid life insurance for full-time staff
- Voluntary life and disability insurance for full-time staff
- Paid Time Off
Our mission is to establish a culture that reinforces the values necessary to be the premier health services provider and employer in each of the communities we serve. We understand that choosing where you want to go in your career is a big decision. We would like the opportunity to show you that North Shore Health is the Right Choice for you.
Expected salary:
Location: Wisconsin Dells, WI
Job date: Wed, 23 Jul 2025 22:18:14 GMT
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