Diversicare Healthcare Services & Diversicare Therapy Services

  • Clinical Reimbursement Specialist - RN

    Job ID
    Regular Part-Time
    Location Name
    Chanute Nursing & Rehab Center
    530 West 14th Street
  • Overview



    Diversicare is a premier provider of post-acute healthcare services with a strong legacy of quality care. We strive to foster a culture of transparency, support, and innovation. Our Mission is to improve every life we touch by providing exceptional healthcare and exceeding expectations . We are proud to provide work/life integration for our team members and offer a comprehensive benefits package.


    Diversicare operates 76 centers in ten states primarily in the Midwest, Southeast and Southwest. As Diversicare team member, you will play an instrumental role in the care of our patients and residents, our most important responsibility. We are seeking compassionate team members to assist our patients and residents with activities of daily living. We are committed to providing a supportive and collaborative work environment for our team members. A qualified candidate is responsible for all key accountabilities in a manner that is reflective of Diversicare’s Mission and Core Values: Integrity, Excellence, Compassion, Teamwork, and Stewardship. If you are looking for an opportunity to make a difference in the lives of patients and residents you serve, Diversicare is the place for you.


    The key role of the Clinical Reimbursement Specialist is to ensure that the RAI process at each facility is being completed/coordinated in a timely and accurate manner that is in compliance with federal and state regulations.  In addition to these responsibilities, the following expectations, which are not all-inclusive, will guide the Clinical Reimbursement Specialist:


    1. Train and consult with RNACs and MDSCs on the RAI, Medicare, Medicaid and Managed Care processes to facilitate compliance, integrity and accurate reimbursement.
    2. Train and consult with Center staff and Administration on the RAI, Medicare, Medicaid and Managed Care processes to facilitate compliance, integrity and accurate reimbursement.
    3. Function as the subject matter expert for the regional team on the RAI, Medicare, Medicaid and Managed Care processes
    4. Utilize Electronic Health Record and other available data systems to audit and monitor integrity of:
      • RUG Trends
      • ALOS
      • ADL Coding Accuracy
      • Overall RAI process
      • Identification and resolution of data integrity issues
      • Medicare, Medicaid and Managed Care program requirements
      • Medicare, Managed Care and Medicaid rates 
    5. Utilize Electronic Health Record and other available data systems to analyze and project Medicare, Managed Care, and Medicaid rates to facilitate accurate identification of provided services.
    6. Review and analyze QM reports, investigate trends, and assist facilities in development and completion of plans to influence improvement.
    7. Train and consult with centers on Medicare, Medicaid and Managed care Documentation Requests to ensure prompt response and corrective action.
    8. Support Centers in retention and recruitment of MDS staff:
      • Complete second level interviews
      • Orient and provide ongoing training
      • Provide recommendations for performance assessment to administrator
    9. Participate in Regional meetings and activities:
      • Quality Reviews
      • QAPI
    10. Participate in Clinical Reimbursement Department Activities:
      • Program Development
      • Trainings






    1. Current license by State Board of Nursing, RN required.
    2. Minimum of 3 years of experience in clinical reimbursement in the long term care setting.
    3. Prior experience in multi-facility management strong preferred.
    4. Excellent communication skills; prior experience in teaching/training preferred.
    5. Computer skills necessary.
    6. ANNAC certification preferred.

    Diversicare is committed to being an equal opportunity employer.  Diversicare does not discriminate in employment opportunities or practices on the basis of race, color, religion, sex (including gender identity), national origin, age, or disability, sexual orientation, citizenship, marital status, veteran status, genetic information, or any other characteristic protected by law.


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