What are the responsibilities and job description for the Utilization Management Nurse position at Confidential Healthcare Facility?
Utilization Management Nurse – IN (this position is NOT REMOTE)
Company: Clinical Consulting Services (CCS)
Location: Serving skilled nursing facilities throughout Evansville and surrounding areas in Southern Indiana.
We are seeking an experienced Utilization Management Nurse to support skilled nursing facilities in Southern Indiana (territories . This role focuses on clinical reimbursement, MDS accuracy, and regulatory compliance, making it ideal for a detail-oriented professional with a strong understanding of the RAI process and a commitment to ensuring optimal reimbursement and quality care.
Benefits:
- Competitive salary and benefits package
- Travel reimbursement
- Opportunities for professional growth
- Supportive regional leadership team
Responsibilities:
- Provide MDS guidance and support to facility-based MDS Coordinators, ensuring compliance with state and federal regulations
- Assist in the accurate completion and timely submission of MDS assessments
- Conduct audits to ensure compliance with reimbursement guidelines and clinical documentation standards
- Educate facility teams on evolving regulatory changes, reimbursement protocols, and best practices
- Collaborate with interdisciplinary teams to enhance clinical outcomes and financial performance
- Support facilities in optimizing case mix, PDPM reimbursement, and quality measures
Requirements:
- Active RN or LPN license
- Minimum of three years of MDS/RAI experience in a skilled nursing setting
- Strong knowledge of PDPM, Medicare/Medicaid reimbursement, and regulatory guidelines
- Experience in training and educating MDS teams
- Ability to travel within IN
If you are an experienced clinical reimbursement professional looking for a regional leadership role, we encourage you to apply today!
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