Regional Director of Case Management

Regional Director of Case Management & Clinical Reimbursement

As a Regional Director of Case Management, you will play a critical role in providing strategic leadership in the RAI process, care planning, compliance, and clinical reimbursement to maximize patient access to insurance benefits and ensure regulatory compliance.

Responsibilities

• Provide education, support, and review of Medicare, Medicare Advantage, commercial insurance, and Medicaid cases to maximize reimbursement and maintain compliance.
• Collaborate with Regional Case Managers and facility teams to monitor processes and ensure appropriate follow-through.
• Provide guidance and support for facility Utilization Review meetings.
• Conduct analytical reviews of PDPM and RUGs reimbursement data to identify trends and opportunities for program development and operational improvement.
• Ability to respond quickly and effectively in emergency patient care situations.
• Oversee the hiring, onboarding, and ongoing education of Case Management nurses
• Provide continued training and support related to reimbursement, compliance, and case management processes

Qualifications

• Must possess a degree in Nursing from an accredited school or be a graduate of an approved RN program.
• RAC certification preferred.
• Experience in a hospital, nursing care facility, or related healthcare facility.
• Working knowledge of Medicare, Medicaid, managed care programs, the RAI process, clinical reimbursement, and compliance regulations and guidelines.
• Experience using Microsoft Word, Excel, and electronic medical record (EMR) systems.

Benefits

• Medical, Dental, and Vision Insurance
• Paid Time Off (PTO)
• Paid Holidays
• Career Growth and Professional Development Opportunities