Clinical Reimbursement Program Manager
Company: Laurel Health Care Company
Location: Westerville
Posted on: June 25, 2025
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Job Description:
The Clinical Reimbursement Program Manager is responsible for
the development and implementation of clinical reimbursement
programs, compliance tools, and educational initiatives to support
accurate, compliant, and optimized reimbursement processes across
the organization. The role serves as a strategic partner to
facility, regional and corporate leadership, ensuring consistency
and best practices in MDS processes, PDPM optimization
(reimbursement optimization), and regulatory compliance. This role
will oversee Michigan and Ohio skilled nursing facilities. Join us
with an attractive benefits offering: Competitive pay Medical,
dental, and vision insurance 401K with matching funds Life
Insurance Employee discounts Tuition Reimbursement Student Loan
Reimbursement Responsibilities: Design and implement clinical
reimbursement programs to support accurate RAI/MDS assessments and
PDPM accuracy. Develop and maintain compliance tools, audit
processes, and documentation standards related to reimbursement.
Conduct root cause analyses of reimbursement trends, denials, and
documentation deficiencies; recommend corrective actions. Provide
ongoing education, training, and competency validation to Clinical
Reimbursement Specialists, MDS Coordinators, IDT members, and
nursing staff on reimbursement best practices. Monitor regulatory
changes affecting Medicare, Medicaid, and other payor sources;
update internal processes and tools accordingly. Collaborate with
clinical and operational leadership to align reimbursement
strategies with resident care goals and quality outcomes. Support
pre- and post-acute reimbursement audits and assist in developing
response plans for external reviews. Participate in QAPI
initiatives and provide data to support performance improvement.
Assist in onboarding new clinical reimbursement staff and serve as
a subject matter expert. Requirements: Licensed Registered Nurse
(RN) with current, active license in good standing. Minimum of 3
years of experience in clinical reimbursement, MDS, or case mix
management in a skilled nursing facility. RAC-CT certification
preferred. Demonstrated experience developing educational content
and tools for clinical staff. In-depth knowledge of PDPM, MDS 3.0,
Medicare/Medicaid regulations, SNF PPS reimbursement systems, and
regulatory requirements. Ability to travel as needed. Ciena
Healthcare We are a national organization of skilled nursing,
subacute, rehabilitative, and assisted living providers dedicated
to achieving the highest standards of care in five states including
Michigan, Ohio, Virginia, North Carolina, and Indiana. We serve our
residents with compassion, concern, and excellence, believing that
every one of them is a unique person who deserves our best each day
that we care for them. Join us, if you have a passion for improving
the lives of those around you and working with others who feel the
same way. IND123
Keywords: Laurel Health Care Company, Elyria , Clinical Reimbursement Program Manager, Healthcare , Westerville, Ohio
