Remote Regional MDS/PDPM Reimbursement Nurse Consultant

Prestige Healthcare Management; Omaha (NE); On-site; USD 90,000 - 130,000; Full time

Benefits offered by this job

Remote work

Travel reimbursement

Mileage reimbursement

Lodging & meals during travel

Licensure reimbursement

Impactful role

Job summary

Prestige Healthcare Management seeks an experienced Regional MDS/PDPM Consultant to provide remote reimbursement, MDS, PDPM, CMI, and RAI support to long-term care facilities.

Role includes regional oversight for accurate MDS completion, PDPM classification, and reimbursement optimization, with quarterly travel for audits and training. Ideal candidates have RN licensure, MDS expertise, and strong regulatory knowledge.

Qualifications

• Active RN license required.
• Long-term care/skilled nursing experience required.
• MDS experience required.
• Strong knowledge of PDPM, RAI, CMI, Medicare and Medicaid case mix processes.
• Experience with multi-facility MDS oversight preferred.
• RAC-CT certification preferred.
• Experience with Triple Check, Medicare meetings, care planning, and reimbursement audits preferred.
• Strong understanding of RAI Manual requirements.
• Ability to work independently from home.
• Willingness to travel quarterly to assigned facilities.

Responsibilities

• Provide regional oversight for MDS, PDPM, CMI, and RAI processes.
• Monitor timely and accurate MDS completion across assigned facilities.
• Review PDPM classifications, clinical documentation, diagnosis coding, and reimbursement accuracy.
• Support Case Mix Index improvement through accurate assessment and documentation.
• Audit MDS assessments for accuracy, compliance, and missed reimbursement opportunities.
• Review Medicare Part A documentation and skilled coverage support.
• Assist with Triple Check and Medicare meetings.
• Support facility MDS Coordinators, DONs, Administrators, and interdisciplinary teams.
• Review care plans for accuracy and alignment with MDS assessments.
• Monitor ARD schedules, assessment calendars, significant change assessments, and discharge assessments.
• Provide education and coaching to facility MDS and clinical teams.
• Assist with RAI Manual interpretation and regulatory compliance.
• Identify trends, risks, late assessments, coding errors, and reimbursement concerns.
• Participate in monthly or quarterly reimbursement reviews with regional leadership.
• Travel quarterly to assigned facilities for audits, training, and operational support.

Skills

MDS oversight

PDPM knowledge

RAI guidelines

Medicare documentation

Care planning

Reimbursement audits

Multi-facility oversight

Travel readiness

Communication

EHR familiarity

Education

RN license

Tools

PCC/EHR system

Job description

Prestige Healthcare Management seeks an experienced Regional MDS/PDPM Consultant to provide remote reimbursement, MDS, PDPM, CMI, and RAI support to long-term care facilities.

Role includes regional oversight for accurate MDS completion, PDPM classification, and reimbursement optimization, with quarterly travel for audits and training. Ideal candidates have RN licensure, MDS expertise, and strong regulatory knowledge.