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Nexion Health Management - Yazoo City, MS
posted 2 months ago
About the position
The Regional CaseMix Specialist plays a crucial role in coordinating the delivery of services to managed care and Medicare residents across multiple facilities. This position involves collaboration with facility team members to ensure effective treatment, compliance with regulations, and advocacy for residents and their families. The specialist is responsible for monitoring treatment cost-effectiveness, facilitating admissions and discharges, and serving as a liaison with insurance and medical management professionals.
Responsibilities
- Educates new and current facility staff on established Medicare and Medicaid policies and procedures.
- Performs routine audits of facilities for compliance with established Medicare and Medicaid policies and procedures, rules and regulations.
- Educates the facility staff on Medicare and Medicaid utilization following the guidelines of Medicare and Medicaid.
- Knowledgeable of MDS coding and educates facilities in correct coding and selection for MDS assessments for payment.
- Participates in state Medicaid audits and is knowledgeable of state-specific regulations.
- Supervises the Casemix Managers in each area for compliance with the above responsibilities.
- Ensures that the quality and appropriateness of the resident care meets or exceeds company and industry standards.
- Promotes optimal communication among program staff members, facility staff, referral sources, physicians, and residents.
- Accesses the resources of the company's regional offices for consultation and program development support.
- Seeks out external resources through conferences, workshops, etc. as necessary.
Requirements
- Graduate of an accredited school of nursing.
- Must have valid RN/LVN license in state of work (without restrictions).
- Must have a minimum of 5 years of MDS experience.
- Computer skills in Excel, Word, and websites.
Nice-to-haves
- PCC experience is a plus.
Benefits
- 100% Paid Vacation/Sick
- Medical/Dental/Vision
- 401k
- FSA
- HSA
- STD/LTD
- Accident and Critical Illness benefits
- Life Insurance
- AD&D insurance
