Registered Nurse- Regional Minimum Data Set (MDS) Consultant/Clinical Reimbursement

SanStone Health; Greensboro (NC); On-site; USD 85,000 - 110,000; Full time

Job summary

SanStone Health seeks a Registered Nurse- Regional Consultant MDS to support and train MDS Coordinators on the RAI process across facilities, ensuring compliance with laws and company standards. You will review PDPM and Case Mix data to ensure appropriate reimbursement.

The role requires nursing leadership, strong communication, and the ability to travel to facilities as needed, coordinating with regional teams to improve Quality Measures and CMS Five Star outcomes.

Qualifications

• Current RN license issued by the State Board of Nursing.
• Bachelor’s or Associate degree in nursing from an accredited college.
• Minimum 3+ years experience with the RAI process.
• Prior multi-facility experience is a plus.
• Strong knowledge of PDPM and State Case Mix Time weighted Reimbursement.
• Knowledge of nursing and medical practices and applicable laws/regulations for long-term care.
• Excellent verbal and written English communication skills.
• Ability to communicate at all levels and work in a team environment.
• Customer service oriented with ability to work under pressure.
• Strong attention to detail and high productivity.

Responsibilities

• Provides leadership and acts as a resource for regional and facility staff on the RAI, Medicare, and Medicaid programs as applicable.
• Conducts regular monitoring of facility Medicare management and Case-Mix.
• Collaborates with Regional Nurse Consultant to provide education and support for QM and CMS Five Star Rating development.
• Supports accurate claims and billing.
• Leads and participates in program improvement and development efforts related to RAI, Medicare and Medicaid programs.
• Conducts follow-up evaluations to validate systems post-roll-out.
• Participates in the Quality Assurance Process Improvement Program: identifies trends, assists with Root Cause Analysis, suggests solutions, supports follow-up with measurement design.
• Participates in mock survey processes and state/federal survey preparation as requested.

Skills

English communication

Team collaboration

Attention to detail

Organization

Independent decision making

Travel readiness

Microsoft Word

Microsoft Excel

PowerPoint

Internet navigation

Education

Bachelor’s degree in nursing

Associate degree in nursing

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Internet navigation

Job description

The Registered Nurse- Regional Consultant Minimum Data Set (MDS) Consultant 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.

Job Requirements:

• Current license as a Registered Nurse issued by the State Board of Nursing
• Bachelor’s degree or Associate degree in nursing from accredited college
• Minimum 3+ years experience with the RAI process
• Prior multi-facility experience a plus
• Strong Knowledge of Patient-Driven Payment Model (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.