Regional Claims Manager jobs in Pine Bluff, AR

Jefferson Regional Specialty Hospital is a new state-of-the-art facility scheduled to open in Spring 2024 in White Hall, AR. Operated jointly between Jefferson Regional Medical Center and Lifepoint Rehabilitation, a business unit of Lifepoint Health, this new 87,000 square foot 76-bed hospital, housing 40 inpatient rehabilitation beds with an additional 36 behavioral health beds, will be located just north of Pine Bluff and south of Little Rock. If you are an enthusiastic individual seeking an environment dedicated to superior patient care and an organization with a strong mission to serve our community, we invite you to apply!

What you will do in this role:

• Responsible for staff orientation and ongoing education to improve QI score accuracy at admission, throughout the stay and upon discharge. Serves as educator for Quality Indicators (QI) scoring according to Uniform Data System (UDS) training materials
• Serves as a resource to licensed clinicians and clinical staff regarding questions and interpretation of QI scoring guidelines, according to UDS training guidelines, in order to assure the accuracy of the QI scores
• Review medical record documentation using the medical record including UDS Pro-Doc system to support the accuracy and timeliness of the functional scores and comorbid conditions, according to CMS guidelines
• Ensures that the IRF-PAI is consistent with the medical record documentation and reflects the functional status and 24 hour care needs of the patient
• Collaborates with physicians and interdisciplinary team members to ensure the most accurate assessment of the needs and strengths of patients are captured in the UDS Pro-Doc system and in the medical record
• Review current facility clinical documentation in the medical record and UDS Pro-Doc and evaluate accuracy through the use of QI Manager
• Compares actual knowledge of the patient to care provided to the patient and the information contained on the IRF-PAI. Makes appropriate corrections to the IRF-PAI in collaboration with the interdisciplinary team in order to accurately reflect the burden of care upon admission, throughout the stay and upon discharge
• Investigates the Impairment Group Codes IGC and co-morbidities in collaborative manner with the physicians and coders that would allow for accurate coding of the patient’s stay
• Other duties as assigned

• Graduation from an accredited Bachelors of Science in Nursing, Associate Degree in Nursing or Nursing Diploma program or Licensed/Registered PT, OT, SLP
• Current unrestricted state licensure as Registered Nurse (preferred) or PT, OT, SLP.
• CRRN preferred
• CPR/BCLS certification
• UDSMR PPS Certification within 3 years.
• 3 years of experience in the care of patients in the acute hospital or rehabilitation setting preferred

Jefferson Regional Specialty Hospital will provide inpatient rehabilitation services for adults who have experienced a loss of function or disability due to stroke, brain injury, spinal code injury, neurological disorders, orthopedic surgery and other conditions. Featuring all private rooms, the rehabilitation section of the hospital will provide intense, interdisciplinary rehabilitation therapies and medical care to improve patients’ functional independence and help them return home. In addition, Jefferson Regional Specialty Hospital’s distinct behavioral unit will offer a continuum of inpatient and outpatient behavioral health services for adults and seniors, including crisis stabilization for acute mental health and substance use disorders; detoxification from alcohol and drugs; and treatment for anxiety, depression, post-traumatic stress disorder and many other behavioral health illnesses.