Clinical Reimbursement Review Nurse

FutureCare • Full-time • Pasadena, MD, US • 1m ago

Overview

Clinical Reimbursement Review Nurse is responsible for data collection and data entry that represents the residents’ level of care requirements into the utilization software for Maryland Medicaid, in accordance with Federal and State guidelines for residents applying for or continuing a stay in long term care utilizing Medicaid benefits.

Responsibilities

Duties and responsibilities of this position include, but are not limited to the following tasks and assignments:

A. Clinical: Responsible for the collection and data entry of elements needed to support application or continued stay in long term care utilizing Maryland Medicaid benefits.

Maintains a system to identify and work through cases due for review in a timely manner. Reviews relevant electronic health records (EHR) such as the MDS, interdisciplinary documentation, and provider documentation and accurately enters/uploads required clinical information into the utilization software that accurately supports the resident’s level of care. Reviews case mix boards and supporting documentation to ensure accurate and complete documentation for utilization software entry. Identifies active diagnosis codes and relevant documentation to include in utilization software upload to demonstrate overall resident status. Queries and communicates effectively with interdisciplinary team (IDT) to ensure accurate representation of resident is documented within the electronic health record. This will include daily documentation as well as evaluations, plans of care, Preadmission Screening and Resident Reviews (PASRRs) and MDS assessments. Ensures that all resident assessments are completed within the allocated time frames within the utilization software.

B. Administrative:

Abides by the standards identified in FutureCare’s Statement of Corporate Ethics and the Corporate Compliance Plan. Participates in Reimbursement Team Performance Improvement activities Participates in developing goals for the department. Assists in identifying strategies and targets dates for goal attainment.

C. Communication: Promotes effective relationships and communication with all staff, residents, and families.

Reviews changes in resident condition with the IDT to validate status prior to documenting in the utilization software. Promptly communicates any concerns with a resident’s level of care to the appropriate center leadership and to the Director of Clinical Reimbursement. Communicates any opportunities for improvement in electronic health record documentation to the appropriate center leadership and to the Director of Clinical Reimbursement. Communicates with the Maryland Medicaid Utilization Agent as indicated to ensure timely completion of required tasks. Identifies and diffuses stressful/conflict situations related to verbal and non- verbal communication problems with follow-up resolution. Communicates pertinent information and requests through established channels. Interacts with others in a considerate, helpful, and courteous manner.

D.Professional Development: Seeks opportunities for own growth and expansion of responsibilities.

Attends meetings as directed. Participates in education workshops/programs to increase professional competence to meet professional goals. Presents a neat appearance in appropriate dress and identification as required by position. Participates in self-evaluation by discussing with supervisor strengths, weaknesses, objectives, and goals. Attends mandatory in-services.

Other relevant duties as assigned.

I have read and understand the functions and requirements of this position. I understand that this is not to be considered as an exhaustive statement of duties, responsibilities or requirements and does not limit the assignment of additional duties for this position.

Qualifications

Current Maryland or Multistate Registered or Licensed Practical nursing license (preferably with Minimum Data Set (MDS) training and experience). Computer literacy is required.

Related Jobs

Dialysis Clinical Manager Registered Nurse - RN

Fresenius Medical Care • Full-time • Baltimore, MD • 3d ago

RN Manager/Supervisor

About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. As the facility leader, you will be part of a close-kn...

3d ago

VIEW JOB

Registered Nurse (RN) Weekend Supervisor

Autumn Lake Healthcare at Alice Manor • Full-time • Baltimore, MD, US • 1w ago

RN Manager/Supervisor

Join our wonderful team as a Registered Nurse (RN) Weekend Supervisor today! Autumn Lake Healthcare at Alice Manor is an exceptional team-oriented company hiring for Registered Nurse (RN) Weeken...

1w ago

VIEW JOB

Regional Director of Nursing (DON)

Autumn Lake Careers • Full-time • Baltimore, MD, US • 1m ago

RN Director of Nursing

J oin our wonderful team as a Regional D irector of Nursing (DON) today! Autumn Lake Healthcare is an exceptional team-oriented company hiring for Regional Director of Nursing (DON) ! We provide ou...

1m ago

VIEW JOB

Registered Nurse RN Weekends Sign-On Bonus $7,500

FutureCare • Full-time • Baltimore, MD, US • $35 - $43 / hour • 1m ago

Overview At FutureCare our Registered Nurses are our frontline heroes and are the heart of healthcare. Through their unwavering commitment and hands on approach to deliver the highest standards of quality, our talented...

1m ago

VIEW JOB

RN: Pre-Post Op Outpatient Surgery

Fresenius Medical Care • Full-time • Baltimore, Maryland, United States • 1m ago

RN Outpatient

PURPOSE AND SCOPE: Supports FMCNA's mission, vision, core values and customer service philosophy. Adheres to the FVC/FMCNA Compliance Program, including following all regulatory and FVC/FMS policy requirements....

1m ago

VIEW JOB

Assistant Director of Nursing (ADON)

Autumn Lake Healthcare at Riverview • Full-time • Essex, MD, US • 4d ago

RN Director of Nursing

Join our wonderful team as an Assistant Director of Nursing (ADON) today! Autumn Lake Healthcare at Riverview is an exceptional team-oriented company hiring for Assistant Director of Nursing (ADON)...

4d ago

VIEW JOB

RN Unit Manager $10,000 Sign On Bonus

FutureCare • Full-time • Baltimore, MD, US • 1w ago

RN Manager/Supervisor

Overview At FutureCare our RN Unit Managers are highly regarded as health care providers that lead a dedicated nursing team. They have a positive impact on staff and residents and set the standard of excellence for o...

1w ago

VIEW JOB

RN Director of Nursing, DON

Fayette Health and Rehabilitation Center • Baltimore, MD, US • 1w ago

RN Director of Nursing

Fayette Healthcare Center, a member of the CommuniCare Family of Companies , is currently recruiting an experienced and compassionate RN to lead our nursing team as Director of Nursing ! CommuniCare...

1w ago

VIEW JOB

Registered Nurse RN $7,500 Sign On Bonus

FutureCare • Full-time • Baltimore, MD, US • 2w ago

2w ago

VIEW JOB

RN Registered Nurse

Blue Point Healthcare Center • Full-time • Baltimore, MD, US • $50 / hour • 1m ago

A DEEPER COMPASSION, FOR A HIGHER PURPOSE Nurses are at the heart of our world-class, patient-centered standard of care. Day in and day out, they go the extra mile to make a lasting difference in the lives of our r...

1m ago

VIEW JOB