Regional Clinical Reimbursement Specialist

🕒 3 days ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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This company has sponsored H1B visas in the past.

👻 Ghost score 20%

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PACS

WebsiteLinkedInAll Job Openings

201 - 500 employees

💼 Consulting

📦 Logistics

🏥 Healthcare

Consulting • Logistics • Healthcare

PACS is a holding company with subsidiaries forming a national platform focused on post-acute care facilities, senior living communities, and related ancillary services. The company is committed to transforming the delivery and perception of post-acute healthcare across the United States. With over 314 locations, 40,000 professionals, and support for 30,000 patients and residents daily, PACS operates in 17 states, contributing significantly to the post-acute healthcare sector. PACS Group, Inc. itself does not provide healthcare services directly but operates through licensed subsidiaries.

📋 Description

• Partner with DONs, Medical Directors, and consultant pharmacists on clinically appropriate psychotropic stewardship • Lead falls-with-injury, pressure injury, and infection-prevention programs • Strengthen restorative nursing, continence programs, and mobility plans • Reduce avoidable hospitalizations through early change-of-condition recognition, physician communication, and family engagement • Drive influenza vaccination and support restraint-free care • Run QAPI performance improvement projects with measurable goals • Provide care teams with resident-level reports and specific clinical next steps • Round on units to observe care, coach staff, and confirm care plans match bedside practices • Own facility staffing-measure performance and drive improvement • Work with HR and nursing leaders on RN retention, onboarding, and competency • Validate PBJ submissions and cost report staffing hours • Audit MDS coding for accuracy • Review CASPER/QM reports monthly and complete pre-snapshot data accuracy reviews • Ensure compliance with the RAI Manual, CMS and AHCA rules, and company compliance policy • Maintain facility-level QIP scorecards and quarterly point plans • Target near-miss measures and year-over-year improvement credits • Own facility credentialing roadmaps • Track AHCA rule changes and the 2027 rebase • Support Medicare PDPM and managed care MDS accuracy

🎯 Requirements

• Active Florida RN license • 3+ years of multi-facility MDS/clinical reimbursement experience • Expert knowledge of the RAI Manual, CMS QMs, and Five-Star • Working knowledge of Florida Medicaid PPS and QIP scoring • Strong Excel/data skills • Ability to influence without direct authority • RAC-CT/RAC-CTA preferred • QAPI leadership with measurable QM gains preferred • Joint Commission or Quality Award experience preferred • PointClickCare proficiency preferred • Ability to sit for extended periods while performing data analysis, documentation reviews, reporting, and administrative duties • Ability to stand and walk regularly throughout healthcare facilities to conduct clinical rounds and observe resident care • Ability to use a computer, telephone, and other office equipment for extended periods • Ability to occasionally bend, reach, and lift or carry light materials while conducting facility visits and clinical reviews

🏖️ Benefits

• Equal opportunity employment • Travel between assigned facilities for meetings, audits, training, and program oversight

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