Published on 11 years ago

Location: St. Louis Park

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Position : Clinical Reimbursement Supervisor
Location : St. Louis Park, MN 55426
Years of Experience : 1+ to 2 Years
Job Status : Full Time
Education Level : Bachelor’s Degree
Career Level : Entry Level

Clinical Reimbursement Supervisor

About the Job
Sholom, one of the premier healthcare and senior services organizations in the Twin Cities, has a full-time opening for a knowledgeable, skilled Clinical Reimbursement Supervisor at its beautiful 17 acre campus in St. Louis Park.

The Clinical Reimbursement Supervisor will (a) manage the overall process, staff supervision and tracking of all Medicare/Medicaid case-mix documents in order to assure appropriate reimbursement for services provided within Sholom; (b) conducts concurrent MDS (Minimum Data Set) reviews to assure achievement of maximum allowable RUG (Resource Utilization Group) categories; and (c) integrates information from Nursing, Nutrition Services, Social Services and Rehabilitation to ensure appropriate reimbursement.

Perform revenue optimization and resource utilization practices and analysis.

· Track Medicare and HMO residents to determine continued and appropriate eligibility and benefit period by determining skilled level of need.
· Prior to admission, review pre-admission intake information with the Admissions Nurse to estimate RUG levels for Medicare residents and to identify potential resource costs, consider formularies, and communicate findings to Administrator/care team as needed.
· Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture of appropriate clinical information. Identify opportunities to enhance reimbursement.
· Direct the interdisciplinary team process to communicate opportunities to ensure capturing of all resources.
· Attend monthly meeting with Business Office and Rehabilitation, to review all PPS (prospective payment system) residents for billing, certification, diagnosis, MDS, and other factors (Triple check).
· Manage routing for log for skilled and managed care for transitional care unit and ensures that MDSs are done accurate.
· The supervisor will perform diagnosis sequencing for skilled and managed care for transitional care unit
· Ensures that certifications are done and signed timely per guidelines
· Supervises and ensures that MDSs and CAAs are done on a timely basis and coordinates with the MDS staff to facilitate needs/resources.
· Investigates issues that pertain to inaccurate MDSs, performs root cause analysis, provides feedback and education to MDS coordinator(s) as needed and consults with DON and HR for any corrective action.
· Ensures that the Medicare A and Medicare B denials are issued and scanned in the residents EMR.
· Will take part in collaborative Medicare meetings with therapy to coordinate/manage rehab minutes. Will communicate any changes to ARD, Assessments to the MDS staff and ensure that the MDSs reflect the changes
· Will schedule the LTC and the post acute care unit MDS (Annual, Quarterly, significant changes for LTC) and ensure that MDS coordinators perform MDSs as assigned.

Maintain and monitor MDS schedule and tracking.
· Maintain all MDS assessments to include the proper reference dates throughout the resident’s stay and ensure the accurate and timely submission of the MDS assessments including case-mix, OBRA (Omnibus Budget and Reconciliation Act) and PPS schedules. Communicates to IDT the MDS assessment schedule to ensure timely facilitation of the MDS and care planning process.
· Completes the admission and discharge racking form and maintains tracking system for admission/re-entry/discharge.
· Manage the data entry function to ensure the accuracy of the MDS and verify electronic RAI team transmissions to Point Right QI checks prior to state submission.

Coordinate billing process.
· Coordinate with the Business Office to communicate and verify accurate billing; including contract exclusions.
· Maintain the Managed Care contract manual to ensure timely communication with appropriate departments and staff.

Provide Medicare and Managed Care reimbursement education to Sholom staff.
· Serve as the resource for MDS/RUGs, Managed Care and state case-mix systems to staff and families as needed (register for list serve for MDH/CMS).
· Provide case-mix education to the interdisciplinary team as appropriate.
· Instruct Sholom staff in terminology, language, and format that is required by MDS.
· Communicate with Director of Nursing, interdisciplinary team and Business Office regarding any changes in case-mix regulations such as PPS (prospective payment system) and/or state specific case-mix systems.
· Train back-up staff for the Clinical Reimbursement Supervisor.

Perform administrative and documentation duties as required.
· Assist in the preparation of all requests from appropriate state and/or federal regulatory agencies or agents regarding payment of services (reconsideration, denials appeals, etc.).
· Maintain all MDS, case-mix and Point Right reports and transmission data in an electronic format and store in electronic storage files.

· Able to adhere to the Residents Bill of Rights, HIPAA, and the Nurse Practice Act.
· Able to keep current on changes in the industry, including clinical and regulatory changes.
· Able to comply with established Infection Control and Safety Guidelines.
· Initiative and judgment in determining the needs of residents and maintaining patient care delivery in conformance with recognized standards.
· Good human relations skills and the ability to monitor and direct the activities of others. Patience, tact, courtesy, and kindness when dealing with the residents, family, physicians, and other staff.
· Understand the importance of supporting the organization, residents/families/customers and other Sholom employees.
· Able to display high levels of customer service, responding promptly and thoroughly to the inquiries and needs of individuals both internal and external to the organization in accordance with our PROUD standards.
· Excellent interpersonal skills to interact effectively with a variety of people and personalities inside and outside the organization. Able to effectively handle interactions at all levels and to respond appropriately in sensitive situations.
· Communicate clearly and effectively both orally and in writing to all levels of people inside and outside the organization, including possessing good English speaking skills, fluency and understandability.
· Strong computer skills including Microsoft applications such as Word, Excel, and Outlook, and other applicable clinical packages.
· Detail-oriented, organized and applies effective time management skills in order to meet all deadlines. Able to work under pressure and work independently.
· Able to verbalize understanding of written documentation, instructions, general policies and procedures.

Education, Experience and Credentials
· Graduate of an accredited school of Nursing required.
· Must have current licensure as an RN in the State of Minnesota and must maintain licensure.
· One year of long term care clinical nursing experience is required.
· Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and/or case management preferred.

If you’re interested in working for an organization committed to providing high quality care and services to elderly adults, come join the Sholom team!
Submit applications online at\employment


Position : Director of Housing
Location : St. Louis Park, MN 55426
Years of Experience : 2+ to 5 Years
Job Status : Full Time
Education Level : Bachelor’s Degree
Career Level : Manager (Manager/Supervisor of Staff)

Director of Housing

About the Job
Sholom is one of the leading senior housing and healthcare service organizations in the Twin Cities. We are seeking an energetic, results-oriented, customer focused style Director of Housing that has strong people and leadership abilities to join our Sholom Home West team at our beautiful 17-acre campus conveniently located in St. Louis Park. Sholom Home West provides a continuum of high quality long term care services in a warm and caring environment. Sholom’s broad spectrum of services and care for older adults also includes assisted living, rehab,adult day, hospice and home care.

Why choose Sholom?
· Sholom has a 100-year history of providing high quality services.
· We are a talented team of top-notch nursing professionals who thrive on providing exceptional care for our residents and clients.
· Sholom offers opportunities for employee development.
· And, we have great people to work with!

The Director of Housing will supervise the operations, occupancy and housing with service functions for the Knollwood apartments and Roitenberg assisted living housing on the Sholom West Campus. This leadership position will oversee the planning and implementation of all facility programs and projects; establish and maintain open and effective communication with tenants, families, staff and management team; and conduct studies to analyze the effectiveness of programs, identify problem areas and recommend solutions.

Specific responsibilities will include:
· Maintains an efficient operation and a high quality housing staff by recruiting, selecting, training, scheduling, supervising and evaluating all staff.
· Develops strong working relationships and builds professional relationships with department managers, staff members, and service providers to ensure high quality service for our tenants and provide direction regarding operations and organizational goals.
· Reviews contracts with builders, attorneys, architects, management firms and housing consultants and coordinate all internal and contractual services.
· Assists the Campus Administrator and Finance Department with preparation of the annual budget and manage financial resourcesaccording to budget and revenue projections.
· Completes documentation and ensure accurate recordkeeping to meet all regulatory requirements, and submit applications for license renewals for facilities annually.

We seek a results-oriented professional with 3 – 5 years of progressive experience in the management of senior services and a commitment to providing high quality elder care. Incumbent must have demonstrated leadership, communication, and positive influencing skills. A bachelor’s degree in Health Care Administration or related discipline is required; Nursing Home Administrator’s license for the State of Minnesota is preferred. Must be able perform HR-related functions including hiring and selection, orientation and training, managing and evaluating performance, as well administer and comply with HR policies and procedures. Excellent interpersonal, collaboration and relationship building skills are required to work effectively with a diverse group of people and personalities, including
clients, family members, staff and volunteers. Must display a high level of customer service and the understanding of the confidential nature of organization and client information, including HIPPA regulations. PC proficiency with MS Office and excellent communication and presentation skills are essential.
Sholom is committed to providing the highest quality care and services to our clients. We value the contributions of our employees and provide the forum for them to use their skills to deliver exceptional care.
Sholom offers competitive pay and a full benefits package for full-time (30+ hours/week) employees including Medical, Dental, Life and Disability insurance, retirement plan, holiday pay and paid time off.

If you’re interested in working for an organization committed to providing high quality care and services to elderly adults, come join the Sholom team!
Submit applications online at\employment