Clinical Reimbursement Specialist RN
Diversicare Healthcare Services - Columbus, OH

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Regional Director of Clinical Reimbursement - Clinical Reimbursement Specialist

Join the Diversicare team of professionals providing quality healhcare services to our nation's elderly.

We believe in improving every life we touch, providing exceptional healthcare and exceeding expectations.

We live our core values of Integrity, Excellence, Compassion, Teamwork and Stewardship every day

ACCOUNTABILITY OBJECTIVE: Supervise and monitor all aspects of the RAI process to ensure facilities meet RAI and PPS regulatory compliance to ensure residents receive necessary care and services.


1. Current RN license by State Board of Nursing.
2. Minimum of 3 years experience as a MDS Coordinator
3. Prior experience in multi-facility management as a MDS Consultant preferred
4. Excellent communication skills; prior experience in teaching/training preferred
5. Computer skills necessary
6. Must obtain AANAC RAC-CT certification within 1 year of acceptance of position.


The company expects their employees to promote an atmosphere of teamwork with other associates and hospitality and comfort for its residents. In addition to these responsibilities, the following expectations, which are not all-inclusive, will guide the MDS Specialist:

1. Hold weekly regional ALOS and Extensive RUG Focus calls for facilities identified as having the potential for improvement. Follow up would be conducted on areas of concern identified.
2. Monthly facility visits to include: chart audits focused on MDS regulatory compliance and survey prep; attend daily PPS meeting; evaluation of ARD worksheets for optimal ARD selection; evaluate, identify, and provide additional MDSC education.
3. Monthly monitoring utilizing LTCQ and LTCWIN reports:

  • RUGS trends
  • ALOS
  • ADL Coding accuracy
  • Identification and resolution of data integrity issues
  • Assist facilities in identification and resolution of negative MDS & Medicare trends.

4. Review facility QI/QM reports quarterly; investigate trends identified and assist facility in development and completion of MDS related action plans.
5. Needs based:

  • ADL Coding training
  • New MDSC Basic RAI training
  • Assume MDSC role during vacancy
  • Second level MDSC interviews
  • Attend facility surveys
  • Assume facility MDSC role during position vacancies
  • Provide supplemental MDSC support during times of sudden census increase

6. Attend quarterly MDS Specialist Meetings.
7. Participate in MDS related program development and revision.

OTHER JOB DEMANDS: Clerical perception is necessary to prepare records and charts and to organize training programs. A preference for scientific and technical activities for understanding and responding to medical problems and concepts. Ability to interpret operating policies and procedures and to review work performance in determining conformance to these recognized standards. Is around bio-hazardous waste and blood-borne pathogens.

Must have ability to assess residents and have good powers of observation. Must possess excellent critical thinking skills and the ability to foster teamwork. This position may have access to protected health information in patient’s financial and medical records in order to conduct job duties.

Working Conditions: Work is primarily inside. Requires frequent travel with overnight stays.

Physical Effort: Lifting of 50 lbs maximum with frequent lifting of objects weighing up to 25 lbs. Frequent reaching, handling and fingering of instruments, equipment, records, and reports. Long periods of time driving and at the computer. Standing, stooping, bending occurs when conducting assessments of residents.

Sensory Attention: Talking and hearing essential to instruct and supervise interdisciplinary team. Near visual acuity is required to detect changes in condition of residents. Color vision for perceiving changes in residents skin color and colors of medications and solutions. Must have good sense of sight, smell and hearing to conduct proper physical assessments.

Mental Stress: Must have compassion and ability to properly handle emotional situations. Deadlines
for production of MDS/RAPs and care plans can cause long hours and stress to meet state and
Federal guidelines.

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Diversicare is recognized as a premier provider of post-acute care. We have wide ranging services from short term rehabilitation for...