Managed Care Finance Director directs and oversees all policies and procedures for the financial and data operations of managed care contracts. Manages contracts, negotiates and sets rates, and reviews reimbursement levels and managed care agreements to ensure that proper payment practices are utilized. Being a Managed Care Finance Director implements processes that encourage and inform the organization how to increase levels of reimbursements. Requires a bachelor's degree. Additionally, Managed Care Finance Director typically reports to top management. The Managed Care Finance Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Managed Care Finance Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)
Department
Nursing Services
Reports to
Director of Nursing
Reporting to this position
Unit Manager, Charge Nurse, Certified Nursing Assistant
Job Classification
Administrative/Management
Position Purpose
Assists the Director of Nursing in planning, organizing, developing and directing the overall operations of the Nursing Service Department in accordance with local, state and federal standards and regulations, established facility policies and procedures and as may be directed by the Administrator and the Medical Director, to provide appropriate care.
Required Qualifications
Major Duties and Responsibilities
Assists the Director of Nursing in planning, developing, organizing, implementing, evaluating and directing the day-to-day operations of the Nursing Services department, as well as its programs and activities, in accordance with current state and federal laws and regulations.
Interprets and communicates policies and procedures to nursing staff, and monitors staff practices and implementation.
Participates in all admission decisions as indicated.
Participates in daily or weekly management team meetings to discuss census changes, resident changes in status, complaints or concerns.
Assists in evaluating work performance of all nursing personnel and implements discipline according to operational policies.
Participates in QAPI or facility assessment activities as needed, such as carrying out duties assigned as part of a performance improvement committee.
Facilitates, serves, attends or participates in various committees of the facility as appointed.
Ensures delivery of compassionate quality care and nursing supervision as evidenced by adequate staff coverage on the units, general cleanliness, and maintaining optimal resident functions.
Collaborates with members of the interdisciplinary team, physicians, consultants, and community agencies to identify and resolve issues and improve the quality of services.
Assists with oversight of nursing schedules to ensure resident needs, regulatory and budget standards are met.
Participates in the recruitment, hiring and termination of nursing personnel as indicated.
Performs rounds to observe residents and ensure nursing needs are being met.
Conducts observations of nursing care and supervises development of in-service education to ensure nursing staff is competent in current knowledge and skills.
Promotes teamwork, mutual respect, and effective communication.
Monitors, assists and implements the infection control program in accordance to current infection control guidelines to prevent the development and transmission of disease and infection.
Participates in budget development for the nursing department, medical, nursing and central supplies as indicated.
Assists in the preparation of inspection surveys, including staff in-services on survey processes, and participation in mock surveys as indicated.
Participates in the facility’s plan of correction response to an inspection survey and implements any follow-up required for nursing allegations.
Communicates directly with residents, medical and nursing staff, family members, department heads and members of the interdisciplinary team to coordinate care and services and respond to and resolve complaints and concerns.
Assists in oversight of resident incidents and concerns daily to identify any unusual occurrences and reports them promptly to the Director of Nursing, Administrator, and/or state agency for appropriate action.
Monitors for allegations of potential abuse or neglect, or misappropriation of resident property and participates in the investigative process.
Promotes safe work practices, safety rules, and accident prevention procedures to prevent employee injury and illness.
May provide direct nursing care as necessary.
Acts in an administrative/management capacity in the absence of the Director of Nursing and/or Administrator.
Additional Tasks
Personal Skills and Traits Desired/ Physical Requirements/Working Conditions
Compliance as a Condition of Employment and Performance Appraisal
Agreement to abide by all standards, policies, and procedures of the facility, including the facility’s compliance and ethics program, is a condition of employment. Compliance will be a factor in evaluating job performance. Violations, including failure to report violations, will result in disciplinary action, up to and including termination.
This job description is intended to convey the general scope of the major duties and responsibilities inherent in this position. Other tasks not listed here may be assigned by the Administrator. Periodic revision may be necessary to reflect changes in expectations placed on long term care by various governmental agencies. This job description will be reviewed and/or revised annually and as needed.
Individual performance will be evaluated using the following scale:
Unsatisfactory: Achieves results which are far less than the standards identified for the performance factors rated.
Needs Improvement: Achieves results which are less than the standards identified for the performance factors rated. Exhibits the potential to become a competent performer. May be new to job or need skill development.
Meets Standards: Achieves results which meet the standards identified for the performance factors rated. This rating is the expected level of performance.
Exceeds Standards: Achieves results which usually exceed the standards identified for the performance factors rated.
Reasonable Accommodation Statement
Consistent with the Americans with Disabilities Act (ADA) and [insert state civil rights law], it is the policy of [Facility Name] to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact [include name and/or department, telephone, and e-mail address].
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