Regional Director Case Mix Reimbursement

Saint Joseph Healthcare   •  

Tewksbury, MA

Industry: Healthcare


Not Specified years

Posted 172 days ago

This job is no longer available.

Job Summary 


The Regional Director of Case Mix Reimbursement oversees the Case Mix process (MDS/MMQ) in all facilities in accordance with all laws, regulations, and Covenant Health standards.  Position reports to the Director of Finance for Post Acute Care Operations

Essential Duties and Responsibilities 

• Must be able to read, write, speak, and understand the English language

• Must understand and follow company policies, including harassment and complaint procedures  

• Must utilize CMS, state, and LCCA resources to remain current on regulatory requirements, changes, and updates to Case Mix process

• Must provide education and training to facility level staff and Regional Teams on changes, updates, and trends identified

• Must provide training to new MMQ nurses related to Medicaid guidelines and MMQ computer process

• Must provide training to new MDS/PPS nurses to Medicare guidelines and computer process'.

• Must review facility Case Mix process on a routine, and as needed, basis to assure regulatory compliance through appropriate systems management ,

• Must analyze Case Mix Analysis tools on a monthly basis to identify trends and areas of focus and develop strategies

• Must practice dependable, regular attendance

• Must be able to concentrate and use reasoning skills and good judgment

• Must be able to communicate and function in an interdisciplinary team

• Must be able to sit, stand, band, lift, push, pull, stoop, walk, and move intermittently during working hours

• Must prepare facilities for MDS issues and concerns during survey process

• Must provide training at divisional and/or regional training meetings as necessary

• Must prepare facilities for MMQ audits conducted by the state

• Supports and promotes the mission and values of Covenant Health and the Catholic Health Ministry.

• Other duties as consistent with this role.

Job Requirements

• Must have excellent written and verbal communication skills

• Must be proficient in Word, Excel, and email

• Must be knowledgeable of nursing practices and procedures as well as laws, regulations, and guidelines governing case mix functions in long-term care

• Must have ability to interpret and implement programs, goals, objectives, policies, and procedures of Nursing department

• Must stay current on nursing trends and developments

• Must be able to relate information concerning resident's. condition

• Must possess ability to make independent decision• when circumstances warrant such action


Job knowledge and skills

• Long-term care regulations

• MMQ knowledge

• MDS knowledge

• Reimbursement compliance and billing systems


Education & Experience

• Must have Associate'• or Bachelor's nursing degree from accredited college

• Must be currently licensed as RN in Massachusetts

• Must have two years Massachusetts case mix experience - preferably in long-term care

• Must have knowledge of RAI/MDS/MMQ process