Come join an amazing team!

Our care teams are true caregivers. They serve patients with dedication and compassion and are the heart of our patients’ care and recovery. Whether providing direct care or operational support, Priority Management seeks people who share our commitment to providing excellent care to our patients and residents. Our patients are our passion and we invite you to join our team!

Benefits Include:

• Medical
• Dental
• Vision
• Basic Company Paid Life insurance
• Long Term Disability
• Voluntary Life Insurance for the Employee, Employee Spouse and Employee Children
• Short Term Disability, Cancer, Critical Illness, Accidental and Universal Life
• Employee Referral Bonus Potential Program
• Daily Pay
• Tuition Reimbursement
• Paid Time Off

JOB SUMMARY:

To promote, plan, organize, develop, coordinate, and direct our facility teams to support Clinical Reimbursement in accordance with current applicable federal, state, and local standards, guidelines and regulations, and in accordance with our company’s established privacy policies and procedures, to assure that the highest degree of quality resident care and safety can be maintained at all times.

Responsible for the executive oversight of the administration, clinical planning, development and operations of the Minimum Data Set (MDS) program. This position supports regional and facility employees in all aspects of Care Management.

EDUCATION:

Must be a graduate of an accredited school of nursing, currently registered with a state agency for nursing licensure, and hold a valid license in the state he/she is employed.

QUALIFICATIONS/EXPERIENCE:

Experience in geriatric/long-term care nursing documentation, Minimum Data Set (MDS) coding, and/or medical necessity reviews/appeals. Working knowledge of regulatory and payer requirements for reimbursement and reason(s) for denial of claims for Medicare, Medicare Advantage, or Medicaid.

Completion of continuing education on subjects related to case management, regulatory requirements, restorative nursing, medical records documentation, legal aspects of documentation, reimbursement, and compliance.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Medical records review utilizing clinical and regulatory knowledge to determine required supporting documentation
• Clinical nursing review of patient records for compliance with facility practices and procedures as directed
• Flexibly manage tasks to meet deadlines by re-prioritizing workflows in a production-oriented setting
• Employ critical thinking to identify/resolve issues and provide timely feedback regarding medical review processes
• Develop appeal arguments using clinical evidence, supporting references/regulations, and participate in appeal hearings by providing testimony, as required
• Determine regulatory and clinical support for appeal arguments when pre-existing resources are unavailable
• Proficiently review and synthesize abstract information from handwritten/electronic medical records to support claims
• Agree not to disclose assigned user ID code and password for accessing resident/facility information and promptly report suspected or known violations of such disclosure to the Director of Medical Records.
• Agree not to disclose resident’s protected health information and promptly report suspected or known violations of such disclosure to the Director of Medical Records.
• Report any known or suspected unauthorized attempt to access facility’s information system to Director of Medical Records.
• Attend and participate in mandatory in-service training programs, workshops, seminars, etc., as approved / delegated.
• Ensure full compliance with HIPAA regulations
• Working knowledge of ICD-10, CPT coding, HCPCs, and MDS item coding for PPS/PDPM and OBRA assessments
• Proficiency in Medicare rules and regulations including coverage, benefit periods, certification, qualification criteria, 30-day rule, etc.
• Respond appropriately to behavioral, medical, and fire safety situations
• Other duties as assigned

Priority Management Group, LLC is an Equal Opportunity Employer that does not discriminate on the basis of actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, arrest record, or any other characteristic protected by applicable Federal, State or Local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment. Management Group, LLC is an Equal Opportunity Employer that does not discriminate on the basis of actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, arrest record, or any other characteristic protected by applicable Federal, State or Local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

Job Type: Full-time

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift

Work setting:

• Nursing home

Work Location: In person