RN MDS & Reimbursement Consultant

PruittHealth; Savannah (GA); On-site; USD 90,000 - 120,000; Full time

Job summary

PruittHealth in Savannah, GA seeks an experienced Case Mix Director / MDS Nurse to lead RAI processes, care management, and related software usage to ensure appropriate resident care and timely reimbursement. The role requires managing case mix, PPS and compliance across facilities, with oversight of MDS accuracy and staff education.

Responsibilities include data distribution, education of center partners, policy adherence, and PI participation.

Qualifications

• Knowledge of state and federal regulations related to RAI and reimbursement.
• RN license active in the state of residence.
• Bachelor's degree in Nursing or Allied Health required.

Responsibilities

• Distribute current and revised RAI/PPS/Case Mix information to partners promptly.
• Provide status updates on clinical and financial reimbursement to regional and corporate staff.
• Participate in professional organizations to strengthen RAI/process knowledge.
• Educate center partners on RAI, Care Plan, PPS and Case Mix processes and their impact.
• Instruct on reading and using various state, federal, and company reports.
• Offer consultation to ensure MDS accuracy and policy compliance.
• Identify trends and drive PI plans via analysis of reports.
• Maintain knowledge of clinical software, billing systems, and support resources.
• Interview applicants for CMDs/MDS Nurse and advise hiring authority.
• Oversee orientation process for new CMDs.
• Adhere to privacy guidelines for residents' PHI.
• Participate in PI activities; frequent overnight travel may be required.

Skills

Regulatory knowledge

RN license active

Nurse Assessment Coordinator preferred

Microsoft proficiency

Education

Bachelor's degree in Nursing or Allied Health

Tools

MatrixCare

Pointright

Microsoft

Job description

PruittHealth in Savannah, GA seeks an experienced Case Mix Director / MDS Nurse to lead RAI processes, care management, and related software usage to ensure appropriate resident care and timely reimbursement. The role requires managing case mix, PPS and compliance across facilities, with oversight of MDS accuracy and staff education.

Responsibilities include data distribution, education of center partners, policy adherence, and PI participation.