Clinical Reimbursement MDS Consultant Coastal Region Rocky Mount Fayetteville Elizabeth City NC

SanStone Health & Rehabilitation; Rocky Mount (NC); On-site; USD 60,000 - 90,000; Full time

Job summary

An established industry player in health care is seeking a Regional Minimum Data Set Consultant to provide essential support and training to MDS Coordinators. This role is pivotal in ensuring compliance with the Resident Assessment Instrument (RAI) process, enhancing reimbursement accuracy, and fostering a collaborative environment across facilities. The ideal candidate will possess a strong nursing background, with a focus on PDPM and Case Mix, and will thrive in a dynamic, team-oriented setting. Join a supportive workplace that values professional growth and offers competitive benefits, including medical, vision, and dental insurance, as well as a 401K plan. Your expertise can make a significant impact on the quality of care provided to residents.

Benefits

Medical Insurance

Vision Insurance

Dental Insurance

Pharmacy Plan

401K with Company Match

Qualifications

• Current RN license in North Carolina or Compact State required.
• 5+ years experience with the RAI process preferred.

Responsibilities

• Provide leadership and oversight for regional and facility staff on RAI process.
• Conduct monitoring of facility Medicare management and Case-Mix.

Skills

Registered Nurse License

RAI Process Knowledge

PDPM Knowledge

Communication Skills

Customer Service Orientation

Attention to Detail

Organizational Skills

Teamwork

Flexibility

Confidentiality

Education

Bachelor's or Associate Degree in Nursing

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Job description

Regional Minimum Data Set Consultant MDS provides support, education, and training to the MDS Coordinators in the facilities on the Resident Assessment Instrument (RAI) process in accordance with the laws, regulation, and company standards. Reviews and coordinates PDPM and Case Mix data for the region to ensure appropriate reimbursement.

Benefits:

Benefits include a supportive work environment with opportunities for professional growth. We offer a competitive wage and new benefits packages to include new medical insurance, vision and dental insurance, and a pharmacy plan. We offer 401K with company match. Apply today!

Job Requirements:

• Current license as a Registered Nurse issued in North Carolina or Compact State
• Bachelor’s degree or Associate degree in nursing from accredited college
• Minimum 5 + years’ experience with the RAI process
• Prior multi-facility experience a plus
• Strong Knowledge of PDPM and State Case Mix Time weighted Reimbursement payment system.
• Knowledgeable of the nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to long-term care.
• Effective verbal and written English communication skills.
• Ability to communicate at all levels of the organization and work well within a team environment in support of company objectives.
• Customer service oriented with the ability to work well under pressure.
• Strong attention to detail and accuracy, excellent organizational skills with ability to prioritize, coordinate and simultaneously maintain multiple projects with high level of quality and productivity.
• Ability to work with minimal supervision, take initiative and make independent decisions.
• Approachable, flexible, and adaptable to change.
• Function independently, and have flexibility, personal integrity, and the ability to work effectively with employees and vendors.
• Demonstrate basic to intermediate skills in Microsoft Word, Excel, Power Point, and Internet navigation, preferred.
• High level of professionalism with the ability to maintain confidentiality.
• Ability to travel.

Responsibilities:

• Provides leadership, oversight and acts as a resource for regional and facility staff specific to the RAI process, the Medicare program, and Medicaid Case Mix as applicable.
• Conducts regular monitoring of facility Medicare management and Case-Mix.
• Works in coordination with the Regional Nurse Consultant to provide regional and facility interdisciplinary (IDT) teams with education and support for the development of systems to address and manage Quality Measures (QM) and the CMS Five Star Rating.
• Supports accurate claims and billing.
• Leads and participates in program improvement and development efforts related to the RAI, Medicare and Medicaid programs.
• Conducts follow-up evaluations to validate those systems are functioning well after initial roll-out.
• Participates in the Quality Assurance Process Improvement Program:
• Identifies and evaluates trends
• Assists with Root Cause Analysis
• Assists in identifying appropriate solutions
• Supports facility follow-up through appropriate measurement design
• Participates during “mock survey” process related to RAI with Regional Team as requested, and preparation for state and federal surveys as assigned.