Top 345 E Mds Jobs | SimplyHired

Medical Review Nurse - SNF/MDS Auditor
Machinify —Remote
- Remote
- Nursing
- RN License
- HIPAA
MDS Nurse Coordinator
Frasier —Boulder, CO
- $33.30 - $42.45 an hour
- Full-time
- Background check
- Nursing
- Current TB test
- Commuter assistance
- Disability insurance
Quick Apply
RN/LPN -Skilled Care / PM Full-Time
Cantata Adult Life Services —Brookfield, IL
- $34.00 - $41.50 an hour
- Weekends as needed
- Nursing
- Skilled nursing facility
- RN License
Quick Apply
RN CLINICAL CASE MANAGER
Legent Health —Bellaire, TX
- Full-time
- Nursing
- Mid-level
- US work authorization
- Paid time off
Quick Apply
MDS Coordinator 10K Sign on Bonus
Majestic Care of Hopemont —Terra Alta, WV
- Full-time
- CPR Certification
- Skilled nursing facility
- RN License
- Paid holidays
- Life insurance
Quick Apply
RN / LPN Westerly
ROYAL HEALTH GROUP —Westerly, RI
- $32.00 - $53.50 an hour
- Nursing
- Skilled nursing facility
- RN License
- Paid holidays
- Health insurance
Quick Apply
MDS Assistant RN / LPN
Majestic Care of Goshen —Goshen, IN
- Full-time
- Skilled nursing facility
- RN License
- Word processing
- Paid holidays
- Life insurance
Quick Apply
MDS Coordinator, RN
Majestic Care of Beckley —Beckley, WV
- Full-time
- CPR Certification
- Skilled nursing facility
- RN License
- Paid holidays
- Life insurance
Quick Apply
5d
RN Travel - $75/hr
Pinnacle Alliances/HEALTH —Washington State
- $65 - $75 an hour
- Travel nursing
- Nursing
- Surgery
- Patient monitoring
- Opportunities for advancement
- Flexible schedule
Quick Apply
Dietitian
Bridgewater Health and Rehabilitation —Ocala, FL
- Part-time
- Inventory management
- Writing skills
- English
- Referral program
Quick Apply
13d
MDS Coordinator
Lakeland Rehabilitation and Healthcare Center —Angola, IN
- Up to $40 an hour
- Weekends as needed
- Nursing
- RN License
- Nursing home
- Health insurance
- Dental insurance
Quick Apply
7d
NICU Registered Nurse
VieMed Healthcare Staffing —Covington, LA
- $56.95 an hour
- 12 hour shift
- Blood sampling
- RN License
- Customer service
- Health insurance
- Referral program
Quick Apply
RN Float Pool (Payrate upto $75/hr)
Pinnacle Alliances/HEALTH —Arizona
- Up to $75 an hour
- Travel nursing
- Nursing
- Medication administration
- Surgery
- Opportunities for advancement
- Referral program
Quick Apply
4d
RN Float Pool upto $75/hr
Pinnacle Alliances/HEALTH —Oregon
- $70 - $75 an hour
- Travel nursing
- Background check
- Nursing
- Medication administration
- Opportunities for advancement
- Referral program
Quick Apply
Resident Care Manager LPN - Skilled Nursing / West Seattle, WA
Avamere Rehabilitation at Park West —Seattle, WA
- $38 - $47 an hour
- Full-time
- CPR Certification
- Nursing
- Skilled nursing facility
- Disability insurance
- Health insurance
Quick Apply
RN Float Pool (Payrate upto $75/hr)
Pinnacle Alliances/HEALTH —Montana
- Up to $75 an hour
- Travel nursing
- Background check
- Nursing
- Medication administration
- Opportunities for advancement
- Referral program
Quick Apply
12d
MDS Coordinator / RNAC (RN) - $5,000 Sign-On Bonus
Acts Retirement-Life Communities —Media, PA
- $38.11 - $48.89 an hour
- Online Application
- CPR Certification
- Nursing
- Skilled nursing facility
- Commuter assistance
- Paid holidays
Social Worker at Center
Focused Post Acute Care Partners —Center, TX
- Weekends as needed
- Skilled nursing facility
- Mid-level
- Ability to lift 50 pounds
- Disability insurance
- Health insurance
Quick Apply
13d
Unit Manager/MDS Coordinator- Douglas
SUMMIT RIDGE OC LLC —Douglas, WY
- Weekends as needed
- Nursing
- Skilled nursing facility
- RN License
- COVID-19 protective measures
Quick Apply
1d
RN MDS Nurse
Chamberlin Park —Cincinnati, OH
- Full-time
- Nursing
- Skilled nursing facility
- RN License
- Disability insurance
- Health insurance
Quick Apply

I want to receive the latest job alert for E Mds

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

E Mds jobs near

Medical Review Nurse - SNF/MDS Auditor

Machinify -
Remote

Apply Now

Job Details

Qualifications

RN License
Spreadsheets
Word embeddings
Patient care
Document review
Productivity software
Documentation review
Medical record review for billing accuracy
Documentation reviews

Full Job Description

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We're constantly reimagining what's possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

Please read the description and requirements carefully. This role requires specific MDS experience, so if you do not have that experience then please consider applying for one of our other Medical Review Nurse roles, which may be a better fit for you. Thank you!

Job Summary:

The Medical Review Nurse II - SNF/MDS primarily performs Skilled Nursing Facility (SNF) medical claims audit reviews. As a MR Nurse, you will join a team of experienced medical auditors performing retrospective and prepayment audits on claims for Government and Commercial Payers. You will work remotely in a fast-paced and dynamic environment and be part of a multi-location team.

Key Responsibilities:

Auditing claims for medically appropriate services provided in skilled nursing facility settings while applying appropriate medical review guidelines, policies and rules.
Document all findings referencing the appropriate policies and rules.
Generate letters articulating audit findings.
Support audit findings during the appeals process if requested.
Work collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse.
Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits.
Keep abreast of medical practice, changes in technology, and regulatory issues that may affect our clients.
Work with the team to minimize the number of appeals; Suggest ideas that may improve audit workflows.
Assist with QA functions and training team members.
Participate in establishing edit parameters, new issue packets and development of Medical Review Guidelines.
Interface with and support the Medical Director and cross train in all clinical departments/areas.
Other duties as required to meet business needs.

Knowledge, Skills and Abilities Needed:

Experience with and deep knowledge of ICD-9, ICD-10, HCPCS coding.
Knowledge of PDPM payment Items contributing to payment methodologies.
Ability to maintain high quality work while meeting strict deadlines.
Excellent written and verbal communication skills.
Ability to manage multiple tasks including desk audits and claims review.
Must be able to independently work within Microsoft Office products including Word, Excel, PPT, to Include creating/saving documents in folders, setting up and utilizing spreadsheets, copying and pasting data from one document to another.
Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload.
Effectively work independently and as a team, in a remote setting.

Required Qualifications:

Active unrestricted RN license in good standing, is required.
Must not be currently sanctioned or excluded from the Medicare program by the OIG.
Minimum of five (5) years diversified nursing experience providing direct care in an inpatient or outpatient setting.
One (1) or more years' experience with MDS/ RAI process.
One (1) or more years' experience performing medical records review.
One (1) or more years' experience in health care claims that demonstrates expertise in ICD-9/ICD-10 coding guidelines and how it relates to the MDS RAI Process.
Comprehension of the Uniform Medical Billing Form (UB-04) and application to the MDS billing process.

Preferred Qualifications:

Strong preference for experience performing utilization review for an insurance company, Tricare, MAC, or organizations performing similar functions.
Strong preference for Understanding and in-depth comprehension of PDPM HIPPS codes including HIPPS Clinical Categories and the components that comprise the HIPPS categories.
Knowledge of RUG and LOC commercial payors preferred but not required.
Understanding of Medicare Benefit Payment Manual and Medicare Claims Processing Manual for SNF

Equal Employment Opportunity at Machinify

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/

Apply Now

Refine Your Search

E Mds jobs

Medical Review Nurse - SNF/MDS Auditor

MDS Nurse Coordinator

RN/LPN -Skilled Care / PM Full-Time

RN CLINICAL CASE MANAGER

MDS Coordinator 10K Sign on Bonus

RN / LPN Westerly

MDS Assistant RN / LPN

MDS Coordinator, RN

RN Travel - $75/hr

Dietitian

MDS Coordinator

NICU Registered Nurse

RN Float Pool (Payrate upto $75/hr)

RN Float Pool upto $75/hr

Resident Care Manager LPN - Skilled Nursing / West Seattle, WA

RN Float Pool (Payrate upto $75/hr)

MDS Coordinator / RNAC (RN) - $5,000 Sign-On Bonus

Social Worker at Center

Unit Manager/MDS Coordinator- Douglas

RN MDS Nurse

I want to receive the latest job alert for E Mds

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected