Regional Clinical Reimbursement Specialist
Location: Southern Oregon (Travel Required Across Regional Facilities)
Schedule: Full-Time
About the Role:
We are currently seeking an experienced and dedicated Clinical Reimbursement Specialist to support our skilled nursing facilities across Southern Oregon. Reporting to the Director of Clinical Reimbursement, this position provides leadership, training, and oversight to MDS Coordinators and interdisciplinary teams to ensure compliance with the RAI process and maximize reimbursement through accurate PDPM and Case Mix assessments.
This is a high-impact role ideal for a knowledgeable RN with a strong background in MDS and multi-site clinical support.
Key Responsibilities:
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Act as a clinical resource for MDS Coordinators throughout our Southern Oregon facilities.
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Monitor Medicare and Medicaid Case Mix data for accuracy and reimbursement optimization.
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Support accurate and timely claims and billing processes.
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Collaborate with Regional Nurse Consultants and IDT members to educate and strengthen systems related to CMS Five-Star Ratings and Quality Measures.
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Lead implementation and follow-up audits for new systems, policies, and training programs.
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Participate in QAPI efforts including data analysis, root cause evaluations, and measurable action planning.
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Assist in preparation for state and federal surveys and participate in internal “mock survey” processes.
Qualifications:
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Current and active Registered Nurse (RN) license in Oregon or compact state.
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Associate or Bachelor’s degree in Nursing from an accredited institution.
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3+ years of MDS/RAI experience required.
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Previous experience supporting multiple facilities preferred.
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In-depth knowledge of PDPM and Oregon’s Case Mix reimbursement system.
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Familiarity with long-term care regulations and standards.
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Excellent verbal, written, and interpersonal communication skills.
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Ability to travel throughout Southern Oregon, sometimes on short notice.
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Highly organized, self-motivated, and detail-oriented.
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Proficient in Microsoft Office (Excel, Word, PowerPoint).
Benefits and Perks:
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Opportunities for advancement within a respected and growing healthcare organization.
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Competitive health, dental, and vision coverage for you and your family.
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Company-paid life insurance.
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Health Savings Account (HSA) and Flexible Spending Account (FSA) options.
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Paid Time Off (PTO) and paid holidays.
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Tuition reimbursement to support continued professional growth.
Make a Difference Across Southern Oregon
Join our team and play a vital role in driving quality and compliance in post-acute care. Your clinical insight and leadership will directly impact resident care and organizational success across the Southern Oregon region.
Apply today to become part of a collaborative, forward-thinking team!
