MDS Nurse
The McGuire Group Health Care Facilities
Summary
Northgate Health Care Facility is looking to add an MDS Nurse to its team. In this role, you'll support Medicare, Managed Care, and Medicaid reimbursement processes while helping ensure accurate MDS completion, regulatory compliance, and reimbursement optimization. If you have experience with MDS, PDPM, and long-term care reimbursement, this could be the perfect opportunity for you.
Job description
Responsibilities
- Provide education and support to facility staff regarding Medicare, Medicaid, Managed Care, eligibility, certification, coverage, documentation, utilization, and reimbursement
- Assist facilities with certification procedures, reimbursement-related processes, and resolution of problem areas
- Collaborate with claims review units, compliance teams, and third-party payers to ensure regulatory and company compliance
- Assist with the review and preparation of denied claims, audits, and administrative record reviews
- Monitor reimbursement compliance and establish systems to address areas of non-compliance
- Maintain and analyze reimbursement-related statistical data and utilization trends
- Monitor authorizations and compliance with third-party payer requirements
- Provide ongoing education and training related to reimbursement programs and regulatory changes
- Complete PDPM reviews upon admission, re-admission, or as indicated
- Review Medicare Part A MDS assessments for accuracy and compliance
- Gather documentation for CMS audits and other reimbursement-related audits
- Review physician documentation and assist with accurate ICD-10 coding and diagnosis ranking
- Conduct MDS integrity reviews and complete MDS assessments as needed
- Perform additional duties as assigned
Requirements
- Minimum experience requirement: 2 years of long-term care experience; 4 years of long-term care experience preferred
- Current unrestricted NYS Licensed Practical Nurse (LPN) License OR Registered Nurse (RN) required
- Experience with MDS, PDPM, reimbursement, and quality measures
- Strong understanding of Medicare, Medicaid, Managed Care, and third-party payer requirements
- Excellent time management, organizational, and problem-solving skills
- Strong communication and interpersonal abilities
- Ability to manage multiple priorities and meet deadlines
- Knowledge of long-term care regulations, reimbursement methodologies, and standards of care
- Ability to provide education, training, and support to interdisciplinary teams
Requirements
- Minimum 2 years of long-term care experience
- Current unrestricted NYS Licensed Practical Nurse (LPN) License OR Registered Nurse (RN) required
- Experience with MDS, PDPM, reimbursement, and quality measures
- Strong understanding of Medicare, Medicaid, Managed Care, and third-party payer requirements
- Excellent time management, organizational, and problem-solving skills
- Strong communication and interpersonal abilities
- Ability to manage multiple priorities and meet deadlines
- Knowledge of long-term care regulations, reimbursement methodologies, and standards of care
- Ability to provide education, training, and support to interdisciplinary teams
Benefits
- Paid Time Off
- Weekly Pay
- Same-Day Pay
- Health Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- Employee Referral Bonus Program
- Retirement Saving Options
Company overview
The McGuire Group Health Care Facilities is a prominent healthcare provider organization specializing in skilled nursing and rehabilitation services. Based in the Buffalo, New York region, the company operates multiple healthcare facilities that provide comprehensive medical care, rehabilitation therapies, and long-term care services. The organization focuses on delivering high-quality patient care through its network of nursing homes and rehabilitation centers, serving patients requiring post-acute care, chronic disease management, and specialized rehabilitation services. With a commitment to clinical excellence and patient-centered care, The McGuire Group has established itself as a trusted healthcare provider in Western New York, offering a continuum of care that includes skilled nursing, physical therapy, occupational therapy, speech therapy, and specialized memory care programs. The organization emphasizes creating therapeutic environments that promote recovery and enhance quality of life for patients across various age groups and medical conditions.