Remote Prior Authorization Rn Jobs in Rapid City, SD

MDS Solutions, a division of Key Rehabilitation, is looking for fun, energetic, and self-driven team members to join our remote MDS consulting group.  The role of the Remote MDS Coordinator is to work with our contract partners to plan, organize, and coordinate the completion of the Minimum Data Set (MDS) in accordance with current Federal and State Regulations. If you are looking for something that is flexible and collaborative, come join us!  We thrive on Quality Resident Care.

This role requires a RN license, LPN will not meet the minimum qualifications. 

What do we offer you?

• Creative, fun, and flexible working environment
• The following benefits:
• Competitive salaries and bonuses.
• Comprehensive health and life insurance.
• 401K with discretionary match
• Mileage and licensure reimbursements.
• Flexible Spending Account and HSA
• Reasonable working hours.
• CE opportunities.
• Paid sick, holiday, and vacation leave.
• Promotion/Transfer/Advancement opportunities.
• Meaningful work and job satisfaction.

• MDS scheduling and coordinating to ensure timeliness of assigned sections of MDS per RAI guidelines, including coordinating care plan development and completion with the interdisciplinary team.
• Provide Medicare, Medicaid (case mix), and Managed Care oversight to ensure appropriate clinical services are provided and appropriate reimbursement is received for each resident.
• Develop an individualized, comprehensive resident care plan in collaboration with the interdisciplinary team to ensure care area triggers are addressed.
• Ensure care plans are reviewed quarterly and updated as needed to reflect current resident status with individualized problems, goals, and interventions.
• Review and verify MDS documentation and charting requirements to support the clinical services provided for each resident.
• Ensure timely submission of all Minimum Data Sets to the state data base and ensures that the necessary follow-up action is taken.
• Promote highest degree of quality care through QI/QM data with facility team and identify trends to assist facility in advancing facility processes, improve resident outcomes, and optimize reimbursement.

• Nursing Experience in MDS Assessment: 3+ year
• RAC-CT preferred
• RN Required 
• Thorough understanding of PDPM requirements
• Able to negotiate through EMR and possess strong computer skills
• Promotes and demonstrates excellence in customer service