Pines of Sarasota is currently seeking candidates to join us in the role of MDS Coordinator and Case Manager
The MDS Coordinator and Case Manager is primarily responsible for leading and coordinating managed care processes for residents receiving skilled services in a long-term care/skilled nursing facility. This role focuses on insurance authorizations, continued-stay and concurrent reviews, payer communication, clinical update submission, coverage tracking, Notices of Medicare Non-Coverage (NOMNCs), appeal coordination, and timely follow-up on payer determinations. The Coordinator serves as a central liaison among managed care payers, residents and responsible parties, nursing, therapy, social services, and other members of the interdisciplinary team to support accurate communication, timely reviews, appropriate coverage decisions, and a smooth transition through the skilled stay.
Duties and Responsibilities:
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Complete assigned OBRA, PPS, Medicare Advantage, PDPM, and other required MDS assessments.
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Monitor assessment schedules to ensure timely completion, coding, transmission, and acceptance of MDS assessments.
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Review clinical documentation, ICD-10 diagnoses, and skilled services to support accurate coding and reimbursement.
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Assist with MDS, Quality Measures, Five-Star, CASPER, IQIES, and reimbursement audits.
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Manage insurance authorizations, continued-stay reviews, coverage determinations, and required clinical documentation.
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Track payer communications, authorizations, review dates, and follow-up actions.
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Issue Notices of Medicare Non-Coverage (NOMNCs), coordinate appeals, and communicate coverage updates to residents and responsible parties.
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Collaborate with the interdisciplinary team on discharge planning, insurance issues, and reimbursement-related concerns.
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Escalate urgent authorization, denial, appeal, or discharge planning issues in accordance with facility policy.
The ideal MDS Coordinator and Case Manager candidate will meet the following requirements:
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Current, active LPN or RN license in the state of Florida.
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Knowledge of managed care, Medicare Advantage, commercial insurance authorization, continued-stay/concurrent review, NOMNC, and appeal processes is highly recommended.
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Nursing experience in long-term care, skilled nursing, rehabilitation, or post-acute care preferred; a minimum of five years of relevant nursing experience is preferred.
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Knowledge of MDS 3.0, RAI Manual requirements, PDPM, Medicare, Medicaid, and care planning.
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Completion of RAC-CT required at time of employment or within eight months of starting the position.
At Pines of Sarasota, we value our employees and their well-being. As the MDS Coordinator and Case Manager, you can enjoy a range of benefits, including:
- Swift Access to Pay
- Comprehensive Health, Dental, and Vision Coverage
- 401(k) Plan
- Reduced Onsite Childcare Costs
- $5,000 Sign-On Bonus
- And More...
Ready to join our caring and dedicated team? We make the application process easy! Simply text (941) 376-4254 with the position you are interested in, and we'll set up an interview.
Pines of Sarasota is an Equal Opportunity Employer.
Employment eligibility is subject to a drug screen and a level two background screening.
Background screenings are required for individuals working in AHCA-licensed facilities and Medicaid Provider Enrollment to ensure the safety and well-being of the population we serve. For more information, visit https://info.flclearinghouse.com.
