Clinical Consultant -Full Time

NurseRemotely; United States; Remote; USD 100,000 - 130,000; Full time

Job summary

NurseRemotely is seeking a Clinical Reimbursement Consultant for a fully remote, full-time role in the United States. The RN will perform MDS completion, PDPM coding, budgeting support, and auditing to improve reimbursement and Five-Star outcomes.

You will work independently, report to the Director of Clinical Consulting, and collaborate with SNF clients using EMR systems like PointClickCare or MatrixCare. Requires active RN license and at least five years of MDS experience in SNF settings.

Qualifications

• Active RN license in the United States.
• Minimum five years of MDS completion experience in SNF.
• Knowledge of PDPM reimbursement and case mix management.
• Familiarity with CMS regulations and payor guidelines.
• Proficiency in Microsoft Office applications.

Responsibilities

• Provide interim MDS completion services with accurate scheduling, completion, and submission per RAI guidelines.
• Perform SNF auditing with focus on reimbursement accuracy and case mix management.
• Deliver professional consulting on MDS/Skilled Nursing Facility engagements.
• Maintain up-to-date knowledge of federal and state regulations and payor guidelines.
• Communicate effectively with clients and internal teams; operate remotely with minimal supervision.

Skills

RN

MDS Experience

PDPM Knowledge

RAC-CT Certification

MS Office Proficiency

Remote Work

Communication Skills

Education

Registered Nurse license

Tools

PointClickCare

MatrixCare

Job description

Full-time

Clinical Reimbursement Consultant

Clinical Reimbursement Consultant

Description

Unique remote opportunity for an experienced MDS Nurse to work in a professional atmosphere alongside experienced MDS consultants in the role of a Clinical Reimbursement Consultant.

The successful candidate will excel in critical thinking, accuracy, and excellent communication skills while thriving in an independent remote environment for an organization that is passionate about propelling our clients’ success. This full-time position reports to the Director of Clinical Consulting.

The Clinical Reimbursement Consultant supports SNF’s by providing a variety of consulting services, such as MDS completion, teaching and training, PDPM coding, case mix review, and auditing services that are related to CMS initiatives, regulatory compliance, MDS coding, billing, and reimbursement accuracy, Five-Star rating improvement, facility leadership and operational development, and clinical program development.

Essential Functions of the Job:

• Provide interim MDS completion services, as assigned focusing on accurate scheduling, completion, and submission of MDS following RAI Guidelines
• Provide SNF auditing services with ability to focus on reimbursement accuracy/optimization, Case Mix Management, Quality Measure arrangement, and MDS accuracy reviews.
• Provide professional consulting services, as assigned to Engage Consulting customers focusing on MDS/Skilled Nursing Facility
• (SNF) reimbursement and operations.
• Maintain clinical and regulatory knowledge in accordance with current geriatric care standards of practice, including but not limited
• to Federal Survey Requirements, MDS 3.0 RAI Manual, federal and state health regulations, CMS Requirements of Participation,
• and payor guidelines.
• Consistently demonstrate sound judgement and provides ethical guidance to customers for SNF practices.
• Provide direct assistance to the Senior Practice Manager and Director of Clinical Consulting as requested.
• Must be familiar with Electronic Medical Record (EMR) programs including Point Click Care, Matrix Care, and therapy software systems.
• Ability to work remotely and independently with occasional travel requirements.
• Consistently portray the mission, vision, core values, cornerstones and professional image of Engage Consulting, exercise good judgement in the performance of the job.
• Special projects and other duties as assigned.

Requirements

Required Qualifications:

• Registered Nurse (RN) with active Nursing licensure.
• Prior regional MDS and/or multi-state experience required
• Minimum five years of experience performing MDS completion in a SNF.
• AAPACN Resident Assessment Coordinator Certification (RAC-CT) preferred.
• Intermediate knowledge of SNF Reimbursement and Billing Regulations, including but not limited to RAI guidelines, PDPM
• Reimbursement, Case Mix Management, and specific state nursing documentation guidelines.
• Intermediate knowledge of Microsoft Office (Word, Excel, PowerPoint, and Outlook).

Core Competencies

Healthcare Billing Expertise, Relationship Management, Project Management, Excellent Interpersonal Skills, High Emotional Intelligence, Outstanding Oral and Written Communications, Functional Business Knowledge, Technological Skills, Problem-Solving and Analytical Skills, Critical Evaluation, Cultural Awareness, Ethical Practice, Ability to Exercise Independent Judgment and Discretion, Maintain Confidentiality.