Prospective Payment System Case Manager

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Description of Duties

This position is located at Monroe Community Hospital and is responsible for overseeing and coordinating a prospective payment system (PPS) for Medicare reimbursements, coordinating Medicaid case mix valuation, and coordinating payment requirements established by third party payers. Duties involve projecting the type and intensity of the resources eligible Medicare beneficiaries will use throughout their stay at the Hospital relative to the projected costs.  Duties also involve classifying and maintaining resident payment and care categories in order to document and ensure appropriate reimbursement.  The employee reports directly to, and works under the general supervision of the Deputy Executive Director or other higher level staff member.  General supervision is exercised over a professional staff. 

Minimum Qualifications

Candidates must meet the following minimum requirements on or before the date of the written exam: 

Graduation from high school or possession of an equivalency diploma; plus EITHER:

1. Graduation from a regionally accredited or New York State registered college or university with a Bachelor’s or Master’s degree in Nursing or a health field and two (2) years paid full-time or its part-time equivalent* clinical nursing experience, one (1) year of which must have  been in a skilled nursing facility; OR,

2. Possession of a diploma from an approved nursing program accredited by the National League of Nursing (NLN) or graduation from a regionally accredited or New York State registered college or university with an Associate’s degree in Nursing and five (5) years paid full-time or its part-time equivalent* clinical nursing experience, one (1) of which must have been in a skilled nursing facility; OR,

3. An equivalent combination of education and experience as defined by the limits of (A) and (B) above.

Special Requirements:

Possession of a valid New York State License as a Registered Nurse.

Possession of a valid certification as a Resident Assessment Coordinator issued by the American Association of Nurse Assessment Coordination (must submit copy of certificate with application).

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