Director of Case Mix Management

Job description

Tara Cares, a long-term care administrative support company, is currently seeking a Director of Case Mix Management to oversee supported nursing facilities and supervise the Case Mix Consultants in each region.

Position Summary:

The Director of Case Mix Management consults with supported facilities to verify that correct and compliant utilization of Medicare and Medicaid Services are maintained. Coordinates tracking of Medicare and Medicaid data, educates facility staff on Medicare and Medicaid from a clinical reimbursement perspective and routinely audits to verify facilities are following Federal and State rules and regulations and established Company policies and procedures. Supervises the Regional Case Mix Coordinators.

DUTIES:

• Educates new and current facility staff on established Medicare and Medicaid policies and procedures.
• Performs routine audits of GA facilities for compliance with established Medicare and Medicaid policies and procedures and rules and regulations and conducts periodic audits of supported facilities in other regions.
• Assists the facilities to implement restorative nursing programs.
• Educates the facility staff as appropriate on Medicare and Medicaid utilization following the guidelines of Medicare and Medicaid.
• Complies with Code of Conduct and the Compliance Program when performing work functions.
• Demonstrates knowledge of the Medicare and Medicaid RUG grouper categories and documentation guidelines.
• Demonstrates knowledge of analysis and tracking of the Case-Mix Roster report and makes recommendations accordingly.
• Develops and periodically updates Medicare and Medicaid policies and procedures as changes occur.
• Develops systems to assist in maintaining compliance.
• Assists facilities with development of Action Plans to correct issues identified through audits.
• Communicates with the interdisciplinary and regional team to assist in problem solving.
• Periodically attends facility Medicare meetings, Minute Management, Medicare 7 and Compliance Committee meetings.
• Attends meetings as requested.

QUALIFICATIONS:

• Maintains a current, valid license as a Registered Professional Nurse, BSN preferred, and is in good standing.
• Must possess proficient reading, writing, grammar, and mathematics skills; proficient interpersonal relations and communication skills; knowledge of drug interactions, side effects, and incompatibilities.
• Possesses a minimum of one (1) year of experience in Nursing Service Administration. Additional education or experience in such areas as rehabilitative or geriatric nursing is preferred. Must possess strong knowledge of state, federal and local regulations as they pertain to long-term care. Maintains rapport with outside medical professionals.
• Must be able to travel to supported nursing facilities and meeting locations.

EEO/R/G/V/D