MDS RAI Consultant

LOCATION: 120 Vantis Drive, Suite 200, Aliso Viejo, CA 92656

Position Summary:

Under the direction of the Vice President of Clinical Reimbursement, the Regional MDS RAI Consultant provides support and assistance with the clinical and financial management of Medicare and Medi-Cal residents. This role includes providing education and training to MDS Coordinators and Interdisciplinary Team (IDT) members on MDS and Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) guidelines. The RDCR will work closely with the Clinical Operations team and other key personnel to support clinical operations across facilities.

Qualifications:

- Current state nursing licensure

- Strong organizational and mathematical skills

- Strong verbal and written communication skills

- Previous experience in skilled nursing and long-term resident care

- Experience as a Director of Nursing in long-term care preferred

Responsibilities:

- Collaborate with the Chief Clinical/Nursing Officer, Senior Vice President of Clinical Services, Nurse Resource Consultants, and other Clinical Resource Consultants

- Provide continuous education & training on RAI/MDS Process, Medicare/PPS Management & Clinical Reimbursement, and other clinical education as applicable

- Conduct on-site center visits to review RAI/MDS Process, Medicare/PPS Management, and Quality Measure (QM) reports for accuracy and compliance

- Conduct medical record reviews for RAI/MDS accuracy and complete required facility and/or departmental reports

- Participate in facility Care Management and Triple Check Meetings to ensure compliance with Medicare/PPS Management related policies

- Coordinate monthly Medicare Audits and quarterly Care Management Quality Assurance reviews for assigned facilities

- Act as an educational resource to the MDS Coordinator, Director of Nursing, IDT, etc., based on facility visit/record review findings and/or trends

- Liaise with ancillary providers to establish consistent standards of RAI/MDS and Medicare utilization

Administrative Responsibilities:

- Attend and participate in all assigned meetings, training, education, and in-services as required

- Furnish written reports identifying recommendations, PDPM, QM, and MDS changes at the conclusion of each center review

- Follow up on previous visit’s recommendations, PDPM, QM, and MDS changes, and document these changes

- Meet at least monthly with the Resource Consultant/Clinical Operations Team to review facility/regional trends

- Attend periodic meetings with the VP of Clinical Reimbursement Program

- Conduct exit interviews with Administrator, Director of Nurses, and MDS Coordinator to review report contents

Consumer Service:

- Present a professional image through dress, behavior, and speech

- Adhere to Company standards for resolving consumer concerns

- Ensure all consumer/resident rights are protected

Benefits:

- Competitive pay

- Health Benefits – Medical, dental, and vision coverages with a substantial company contribution (voluntary supplemental plan options available)

- 401(k) with discretionary company match annually

- Company-paid Basic Life and disability insurance (buy-up options available)

- Paid Time Off (Vacation, Sick, Holiday)

- Employee Assistance program

- Tuition Assistance and Professional Enhancement Funds

- Bene-Hub employee-sponsored discount programs and more...

We are proud to be an equal opportunity employer. We are committed to fair and equitable compensation practices and strive to provide employees with total compensation packages that are market competitive. The exact base pay offered for this role will depend on various factors, including but not limited to the candidate's qualifications, skills, and experience.