Clinical Reimbursement Program Manager
Company: Ciena Healthcare Management
Location: Southfield
Posted on: June 3, 2025
|
|
|
Job Description:
The Clinical Reimbursement Program Manager is responsible for
the development and implementation of clinical reimbursement
programs, compliance tools, and educational initiatives to support
accurate, compliant, and optimized reimbursement processes across
the organization. The role serves as a strategic partner to
facility, regional and corporate leadership, ensuring consistency
and best practices in MDS processes, PDPM optimization
(reimbursement optimization), and regulatory compliance.
This role will oversee Michigan and Ohio skilled nursing
facilities.
Join us with an attractive benefits offering:
Competitive pay
Medical, dental, and vision insurance
401K with matching funds
Life Insurance
Employee discounts
Tuition Reimbursement
Student Loan Reimbursement
Responsibilities:
Design and implement clinical reimbursement programs to support
accurate RAI/MDS assessments and PDPM accuracy.
Develop and maintain compliance tools, audit processes, and
documentation standards related to reimbursement.
Conduct root cause analyses of reimbursement trends, denials, and
documentation deficiencies; recommend corrective actions.
Provide ongoing education, training, and competency validation to
Clinical Reimbursement Specialists, MDS Coordinators, IDT members,
and nursing staff on reimbursement best practices.
Monitor regulatory changes affecting Medicare, Medicaid, and other
payor sources; update internal processes and tools accordingly.
Collaborate with clinical and operational leadership to align
reimbursement strategies with resident care goals and quality
outcomes.
Support pre- and post-acute reimbursement audits and assist in
developing response plans for external reviews.
Participate in QAPI initiatives and provide data to support
performance improvement.
Assist in onboarding new clinical reimbursement staff and serve as
a subject matter expert.
Requirements:
Licensed Registered Nurse (RN) with current, active license in good
standing.
Minimum of 3 years of experience in clinical reimbursement, MDS, or
case mix management in a skilled nursing facility.
RAC-CT certification preferred.
Demonstrated experience developing educational content and tools
for clinical staff.
In-depth knowledge of PDPM, MDS 3.0, Medicare/Medicaid regulations,
SNF PPS reimbursement systems, and regulatory requirements.
Ability to travel as needed.
Ciena Healthcare
We are a national organization of skilled nursing, subacute,
rehabilitative, and assisted living providers dedicated to
achieving the highest standards of care in five states including
Michigan, Ohio, Virginia, North Carolina, and Indiana.
We serve our residents with compassion, concern, and excellence,
believing that every one of them is a unique person who deserves
our best each day that we care for them. Join us, if you have a
passion for improving the lives of those around you and working
with others who feel the same way.
IND123
-
Keywords: Ciena Healthcare Management, Battle Creek , Clinical Reimbursement Program Manager, Healthcare , Southfield, Michigan
|
Click
here to apply!
|
