Overview:

The Vice President of Clinical Reimbursement position provides the leadership, consultation and strategy necessary to optimize clinical reimbursement, clinical and reimbursement process development and work flow through analytics, program analysis and work plan development with our partners across the organization. The RN level position requires knowledge of infection prevention and control best practices and strategies. The position accomplishes this through a respectful, constructive and energetic style, guided by the objectives of the company.

As one of the company’s experts and clinical reimbursement support, this position functions as a member of the Company’s clinical strategies consulting division for the Company, in alignment with our mission and values. Must be an RN AND reimbursement specialist and be willing to travel throughout the US. MUST have RAC-CT and SNF experience.

Responsibilities:

Clinical and Compliance Management:

• Provides in-services and training to facility clinical staff as needed
• Functions as a resource for clinical reimbursement program, caseload development, education & training
• Completes remote and onsite PDPM, CMI, MDS & QM audits as indicated
• Participates in teleMDS remote strategic partnership audits as needed
• leads and participates in video conferencing and educational webinars as needed
• Collaborates with Operation, Clinical Strategies and QAC while working on various partnership and internal education, training, strategy, etc.
• Maintains a caseload of consulting clients, working with those clients to set up visits, remote audits, program analysis and work plan and implementation as indicated by each specific contract
• Collaborates with business development in the sale of consulting and rehab services ongoing as well as contract extension
• Participates in ongoing clinical strategies consulting webinars and team calls to discuss strategy and best practice as well as partner and operations education and training
• Stays up to date on industry trends, regulations, reimbursement changes, and other changes as needed to be effective in the current role.
• Plays an active role in ensuring current clients are invoiced according to the services provided

Customer Relationships:

• Fosters excellence in customer relationships and meets with and maintains relationships with key facility leadership through regular written, verbal and in-person communications.
• Addresses customer and employee concerns in timely manner and communicates issues to Senior Management as needed
• Participate in strategic partnership reviews with customer senior management team members for customers
• Reinforces communications from the Company regarding regulatory and other industry updates
• Elicits constructive feedback from all clients on an ongoing basis and as needed to maintain a strong and ongoing partnership.

Marketing & Growth:

• Identifies region growth opportunities in conjunction with Business Development & Operations
• Participates in meetings with prospective customers as requested
• Participates in health care conferences, tradeshows and as requested
• Participates in speaking engagement, state and national as requested
• Participates in orientation and onboarding of new Clinical Strategies Consulting team members as requested.

Qualifications:

• Bachelors, Master’s Degree and or Doctorate Degree in Nursing, Healthcare Reimbursement Specialist or Healthcare educator
• Current license in at least one of the state(s) assigned
• Minimum of 5 years of clinical reimbursement experience
• MDS certification (RAC-CT) preferred
• Proven leadership and program development/supervisory experience, including multi-site management experience, including cross continuum practices
• Knowledge of state, federal and nursing practice act legislation/law and accreditation standards
• Highly skilled in virtual and technological communications and interactions
• Interdisciplinary management and understanding essential
• Must pass Medical and Physical examination based on job qualifications, requirements and duties/responsibilities
• Valid driver’s license and means of personal transportation to service multi state geography as defined
• Course taken and an understanding in infection prevention and control – CDC course completion