Utilization Review Director Jobs in Colorado (NOW HIRING)

As a PDPM Support Specialist, you will play an important role in strengthening clinical documentation, regulatory compliance, reimbursement accuracy, and MDS performance across our skilled nursing facilities. This position provides an opportunity to partner directly with facility and regional leadership while helping clinical teams navigate the complexities of PDPM and Medicare reimbursement.

✔ Multi-facility clinical and reimbursement support role
✔ Opportunity to develop and educate MDS and interdisciplinary teams
✔ Direct impact on documentation accuracy, compliance, and reimbursement integrity
✔ Collaborative partnership with clinical, operational, and billing leadership
✔ Opportunity to strengthen systems and processes across multiple facilities

We are seeking an experienced and detail-oriented PDPM Support Specialist to provide auditing, education, and operational support to our skilled nursing facilities.

The PDPM Support Specialist is responsible for reviewing skilled resident documentation and MDS-related processes to promote accurate Patient Driven Payment Model (PDPM) classification, appropriate reimbursement, and compliance with CMS requirements.

This position will work closely with MDS Coordinators, nursing leadership, interdisciplinary teams, billing personnel, facility Administrators, and regional leadership to identify documentation opportunities, address compliance concerns, provide education, and strengthen facility-level processes.

The successful candidate will possess a strong understanding of PDPM, the Resident Assessment Instrument (RAI), Medicare documentation, HIPPS coding, and skilled nursing reimbursement requirements.

PDPM Auditing & Documentation Oversight

• Conduct comprehensive audits of skilled resident records to evaluate documentation supporting PDPM classification and reimbursement

• Review Medicare Part A and managed care resident records for documentation accuracy, completeness, and compliance

• Evaluate clinical documentation supporting MDS coding and HIPPS code assignments

• Identify documentation deficiencies, inconsistencies, and opportunities requiring additional review or clarification

• Review supporting documentation for alignment with applicable CMS requirements and facility processes

• Conduct audits designed to strengthen preparedness for Medicare Administrative Contractor (MAC) and Recovery Audit Contractor (RAC) review

• Monitor trends in documentation, coding, and reimbursement practices across assigned facilities

• Escalate identified compliance concerns, discrepancies, or potential fraud, waste, or abuse through appropriate organizational channels

MDS Support, Education & Development

• Provide ongoing education to MDS Coordinators and interdisciplinary team members regarding PDPM documentation and CMS requirements

• Provide timely, actionable feedback regarding PDPM capture opportunities, documentation deficiencies, and areas requiring improvement

• Support MDS Coordinators in strengthening the accuracy and consistency of PDPM-related processes

• Provide applicable PDPM section information to facility teams within established timeframes and follow up with leadership regarding utilization

• Educate clinical and operational staff regarding documentation practices necessary to appropriately support resident acuity, services, and reimbursement

• Assist facility teams in understanding the relationship between clinical documentation, MDS coding, PDPM classification, and reimbursement

• Promote a culture centered on documentation integrity, regulatory compliance, and continuous improvement

Collaboration & Operational Support

• Partner with facility leadership and interdisciplinary teams to promote complete and accurate documentation supporting PDPM reimbursement

• Collaborate with the billing department to support timely completion of PDPM-related billing processes

• Communicate audit findings, trends, identified risks, and improvement opportunities to facility and regional leadership

• Follow up on identified deficiencies and support facilities in developing sustainable corrective processes

• Serve as a resource to MDS Coordinators and facility leadership regarding PDPM-related questions and documentation practices

• Maintain organized records of audits, findings, education, recommendations, and follow-up activities

• Support consistency and accountability in PDPM processes across assigned facilities

This is a multi-facility support position requiring regular travel.

• Travel to each assigned facility at least once per quarter

• Conduct on-site documentation and compliance audits

• Provide in-person education, coaching, and support to MDS Coordinators and facility teams

• Meet with facility leadership to review findings, trends, and opportunities for improvement

• Travel by automobile or commercial air transportation as necessary based on assigned facility locations

• Current Registered Nurse (RN) license preferred; Licensed Practical Nurse (LPN) license accepted

• Compact nursing license required, or ability to obtain applicable licensure within one (1) month of hire

• Minimum of one (1) year of experience with PDPM and skilled resident management

• Working knowledge of the Resident Assessment Instrument (RAI) process

• Strong understanding of PDPM methodology, CMS requirements, Medicare skilled services, and HIPPS coding

• Skilled nursing facility documentation auditing experience strongly preferred

• Experience supporting, educating, or mentoring MDS Coordinators preferred

• RAC-CT certification preferred but not required

• Ability to interpret and apply CMS requirements to facility-level documentation and reimbursement processes

• Strong analytical and auditing skills with exceptional attention to detail

• Excellent written and verbal communication skills with the ability to provide clear, constructive education and feedback

• Strong organizational and time-management skills with the ability to manage multiple facilities, audits, deadlines, and competing priorities

• Ability to work independently while maintaining effective communication with facility and regional leadership

• Ability and willingness to travel regularly to assigned facilities

The PDPM Support Specialist is expected to maintain the highest standards of professional integrity and confidentiality.

All responsibilities must be performed in accordance with applicable:

• CMS requirements and guidance

• HIPAA privacy and security requirements

• Federal and state healthcare regulations

• Medicare and Medicaid program requirements

• Organizational compliance policies and procedures

The PDPM Support Specialist is responsible for appropriately reporting identified compliance risks, documentation discrepancies, or suspected fraud, waste, or abuse through established organizational reporting channels.

This position provides an opportunity to expand your expertise beyond individual facility MDS operations and contribute to clinical reimbursement performance across multiple skilled nursing facilities.

You will have the opportunity to develop MDS professionals, strengthen facility systems, collaborate with regional leadership, and help establish consistent standards for documentation integrity, regulatory compliance, and reimbursement accuracy.

If you are an experienced MDS or PDPM professional who combines clinical knowledge with strong analytical, auditing, and educational skills, we encourage you to apply.

Join a team where your expertise can directly strengthen compliance, documentation quality, and operational performance across our skilled nursing communities.

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to any protected characteristic in accordance with applicable federal, state, and local laws.

We are committed to providing reasonable accommodations to qualified individuals with disabilities throughout the application and hiring process. Applicants requiring assistance should contact Human Resources.

• Ability to sit and work at a computer for extended periods while reviewing clinical records and documentation

• Ability to frequently review detailed electronic and written clinical information

• Ability to lift and transport up to approximately 20 pounds of work-related equipment or materials as necessary

• Ability to travel regularly by automobile or commercial air transportation

• Ability to move throughout skilled nursing facilities while conducting on-site audits, observations, education, and meetings

• Ability to perform the essential functions of the position with or without reasonable accommodation