Posted Jul 26, 2026 · Last seen active Jul 27, 2026
About this role
The Regional Director of Clinical Reimbursement provides extensive training, analysis, advice and consultation to the facilities and teams within his/her area of responsibility. Ensures compliance with federal and state regulations, as well as Company policy and procedures regarding state case mix/Medicare and Managed Care payment systems. Monitors, consults, and makes effective recommendations for changes and modifications to existing facility processes, systems, policies, and practices which will assure efficient, effective and compliant state Medicaid/Medicare/Managed Care payment performance.
Travel will be necessary to facilities in Wisconsin, Tennessee, Kentucky, and Florida.
Provides consultation, training and support concerning the Medicare, Managed Care and state case mix payment system for the assigned area.
Analyzes systems and processes to determine that federal and state regulations as well as company policies and procedures are followed. Promotes compliance by performing periodic audits of MDS assessments, supporting documentation, and other relevant data.
Show full description
Recognizes, advises and promotes facility best practices and systems for dealing with state case mix/Medicare and Managed Care payment systems.
Studies, analyze and reports period over period information and systems in order to identify trends and deviations from results in Medicare, Managed Care and State Case Mix Index and takes appropriate actions.
Works in conjunction with teams to resolve issues effecting deviations from expected results. Recommends changes and performs follow-up to ensure that those recommendations are effectively implemented and monitored for appropriateness.
Regularly communicates to management outside the facility on recommendations made to facility management to ensure proper implementation and follow-up.
Serves as a liaison between state and organization related to the state case-mix process, including electronic submission and state MDS requirements related to state payment.
Assists in the recruitment/interview process for MDS Vacancies
Requirements
Healthcare industry recruitment experience, Medicare, Managed care, Performance Reporting, Healthcare documentation compliance audits, CMS regulatory compliance, Medicare regulations, Team training, Centers for Medicare and Medicaid Services (CMS), Centers for Medicare & Medicaid Services (CMS) billing regulations, Medicaid regulations, Medicaid, Quality audits, Regulatory compliance analysis, Senior level, Clinical documentation standards, Process management, Documentation review
About the employer
Bedrock Healthcare
Nursing Home
Bedrock Healthcare Group operates skilled nursing and rehabilitative care facilities across Wisconsin, Kentucky, Florida, and Tennessee. The Beaver Dam Health Care Center, located in Beaver Dam, Wisconsin, is a skilled nursing home facility within this system. The organization employs what…
What reviewers appreciate
+Tuition reimbursement for continuing education
+401k plan matched at 10%
+Comprehensive health insurance benefits
What reviewers flag
−No specific negative aspects were captured in the provided research sources; Glassdoor and Indeed review content was not fully available
Benefits: The benefits package includes tuition reimbursement, health insurance, paid time off, paid holidays, and a 401k plan matched at 10%. The employer also highlights a great work environment as part of the overall compensation offering.
tight-knit familycompassionatepatient-centeredteamwork-orientedstability-focusedspecialized care
Daytona Beach sits on Florida's Atlantic coast, known for its hard-packed sand beaches where you can drive on the sand and the famous Daytona International Speedway. The area offers a laid-back coastal lifestyle with year-round warm weather, NASCAR racing, and seasonal motorcycle events like Bike Week.
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