Regional Reimbursement Nurse

4 weeks ago

Dallas, United States Creative Solutions in Healthcare Full time
Job DescriptionJob Description

MDS Regional Reimbursement Nurse

We SUPPORT the MDS Position

MDS Case Managers DO NOT TAKE CALL and REPORT directly to the Administrator.

Are you passionate about driving MDS Clinical Reimbursement excellence in long-term care? Do you thrive on ensuring MDS Case Managers have support for MDSs, Quality Measures, Medicare and Medicaid Reimbursement? If so, we have the perfect opportunity for you

If you're a dynamic, results-driven professional with a passion for long-term care and a strong understanding of MDS, quality measures, and Clinical Reimbursement, we want to hear from you Join us in making a difference in the lives of our residents and shaping the future of skilled nursing care. Apply now to be part of our team

This role will provide oversight of 5-8 SNF’s in the assigned geographic region.

Job Summary

The ideal MDS Regional Reimbursement Nurse is very detailed oriented, organized, self-motivated and able to effectively multi-task. The Role provides support, education, and training to the MDS Case Managers in the facilities on the RAI MDS process in accordance with the laws, regulations, and company standards. Reviews and coordinates PDPM and Medicaid Reimbursement Data for the assigned region to ensure appropriate reimbursement.

Benefits

  • Health/Dental/Vision Insurance
  •  Ancillary policies including AD&D, STD, Cardiac, Cancer, Critical Illness, Hospital Confinement
  •  Whole and Term Life Insurance
  •  Tuition Reimbursement
  •  Paid Time Off
  •  Immediate 401(k)
  •  Unparalleled Corporate Support

Job Requirements

  • Licensed Nurse in good standing
  • MDS and LTC Experience
  • Working knowledge of MDS, Clinical Reimbursement and Quality Measures
  • Excellent professionalism and organizational skills.
  • Flexibility with your work schedule and being able to work independently.
  • Ability to travel

Job Responsibilities

  • Provides leadership, oversight and acts as a resource for regional and facility staff specific to the RAI MDS process, Medicare program and Medicaid clinical reimbursement process.
  • Providing comprehensive training for systems related to the RAI MDS, clinical software, and Medicare/Medicaid Reimbursement systems.
  • Training new MDS Case Managers to conduct MDSs, develop plans of care, evaluate residents’ responses to interventions, document clinical records, RAI manual and all applicable deadlines for MDSs, and complete MDSs as needed.
  • Provide facility support for QM’s, QIPP QMs, and CMS 5-Star Rating QM.
  • Conducts regular monitoring of facility Medicare and Medicaid Management.
  • Supports accurate claims and billing by training/attending Reimbursement related meetings and ensure processes in place.

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