Regional Clinical Reimbursement Manager, MDS, RAI, PPS, RN
SunBridge Healthcare - Albuquerque, NM

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Job Description:
Celebrate Caring at SunBridge Healthcare. Come Join Our
New Mexico Regional Team! We're seeking a Regional
Clinical Reimbursement Manager for our 10 skilled
nursing centers in New Mexico.
This position is re-opened, after a hold period. Please
re-apply to be considered.
This position is a member of the corporate Medicare
Services Team providing the expertise, guidance,
advocacy, training and information to our centers, our
goal being to ensure appropriate services to our
Medicare Beneficiaries. Assuming the overall
responsibility to evaluate and provide education,
intervention and support for Medicare, RUGS management,
case management, PPS, RAI, state specific and special
contract reimbursement.
  • Advocate for customer benefits
  • Daily on-site consultation to assigned centers and
completion of site visit report.
  • Creating and maintaining a partnership with the
interdisciplinary team (Administrator, MDS Coordinator,
Therapy department, marketing . . .)
  • Utilization of principles of adult education and
appropriate training tools to provide training in groups
and individual sessions for region and center personnel.
  • Attend center stand up and PPS meetings.
  • Review clinical record documentation to determine
appropriate training required.
  • Provides support for center personnel to assist them
in determining appropriate coverage, complete
documentation, accurate assessment, timely
transmissions, and maximum utilization.

Job Requirements:
  • Licensed Registered Nurse, RN in good standing.
  • Extensive experience in RUGS and Case Mangement
  • Extensive knowlege of MDS 3.0 and RUGS 4.0,
Medicare, PPS, and state reimbursement systems.
  • Knowledge of RAI process a plus but not required.
  • Must have at least 3 years of experience in a
regional/multifacility level role.
  • Strong knowledge of case mix and therapy
  • Experience in adult training and education.
  • Extensive travel, including some overnights.
We value our employees. That’s why we offer quality
benefits to you and your family. You can select from
among the following options to create the plan that’s
right for you.
  • Medical, dental, and vision insurance
  • Life insurance for you and your dependents
  • Long and short-term disability
  • 401(k)
  • Paid time off and holidays
  • Healthcare and dependent care flexible spending
  • Employee assistance program
  • MetLaw Hyatt legal service and
  • MetLife additional voluntary benefits
  • PerkSpot employee discount program
  • Dell employee purchase program
  • Verizon employee discount program
SunBridge Healthcare offers equal opportunity employment
in drug-free workplaces.
Keywords: MDS, M.D.S., M D S, Resident Assessment
Coordinator, RAI, R.A.I, Clinical Case Manager, Nurse,
R.N., RN, Registered Nurse, LPN, L.P.N., Licensed
Practical Nurse, Licensed Vocational Nurse, LVN, L.V.N.
Registered Nurse Assessment Coordinator, RNAC, Minimum
Data Set, MDS Coordinator, MDS Nurse, AANAC, America
Association of Nurse Assessment Coordinator, Certified
RNAC, Certified Registered Nurse Assessment Coordinator,
Clinical Reimbursement, Clinical Reimbursement
Specialist, Long Term Care, Case Mix Management, RUGs
  • LI-KH1
Division/Department : SunBridge HealthCare
% of Travel Required : 80-90%
Offer Relocation : Maybe
Manager/Supervisor : Deb Sanderfield
Manager/Supervisor Telephone : please contact recruiter