Utilization Review Jobs in Madison, WI (NOW HIRING)

MDS Solutions, a division of Key Rehabilitation, is looking for fun, energetic, and self-driven team members to join our remote MDS division as a Clinical Reimbursement Specialist.

Clinical Reimbursement Specialist (CRS)
The Clinical Reimbursement Specialist (CRS) plays a critical role in supporting clients through specialized project work, including conducting RAI assessments, developing comprehensive care plans, and delivering targeted education and training to MDS Coordinators on the Resident Assessment Instrument (RAI) process. This work is performed in strict alignment with applicable laws, regulations, and company standards. The CRS also reviews reimbursement systems for PDPM and Case Mix to ensure accurate and optimized reimbursement. Additionally, the CRS provides support with interim long-term and short-term contract coordination, ensuring the smooth completion of these efforts

About Us:

At Key Rehab, we’re shaking up rehab services with a fresh, standout approach. We offer a wide range of services, stick to top-notch systems, and work in strategic locations to get the best results for our patients and support our clients' goals. We’re all about clear communication, using our deep experience to deliver therapy that's both effective and affordable. Our reputation is built on great patient care, happy clients and staff, and solid management. We are proud to exceed expectations for patients, families, healthcare providers, and businesses.

We prioritize both exceptional patient care and the well-being of our employees. We are committed to delivering compassionate, results-driven therapy while offering the flexibility and comprehensive benefits needed to thrive in today’s healthcare environment. Our team is large enough to offer competitive pay and benefits but small enough to ensure personalized attention and support for your career aspirations.

Whether you’re looking for a role that accommodates family commitments, travel plans, home projects, or future savings, we provide tailored solutions to fit your lifestyle. Join us and experience a workplace that values your individual needs and career goals. Come experience a rewarding career where you’re valued and supported every step of the way.

We offer a creative, engaging, and flexible work environment, alongside a comprehensive benefits package designed to support your success and well-being:

• Competitive salaries with bonus opportunities
• Ample opportunities for promotion, transfer, and advancement
• Work that is meaningful, fulfilling, and provides high job satisfaction
• Reasonable working hours promoting work-life balance
• Continuing education (CE) opportunities for ongoing professional development
• Generous paid time off
• Comprehensive health, dental, and life insurance packages
• 401K with discretionary matching
• Mileage and licensure reimbursements
• Flexible Spending Account (FSA) and Health Savings Account (HSA) options

• Serve as a trusted advisor to healthcare agencies and facilities, offering expert guidance and insights to optimize their operations.
• Assist clients in assessing, planning, developing, and implementing systems and processes related to reimbursement, tailored to the specific needs and contracts established with each client.
• Provide consulting services and technical expertise, including interim MDS management, ensuring providers receive the support they need to achieve optimal outcomes.
• Stay up-to-date on professional standards of clinical care, federal and state regulations, QM measures, and the RAI process to ensure the delivery of accurate, compliant, and effective solutions.
• Deliver high-quality, professional services that encompass reimbursement optimization, staff education, in-depth research, system analysis, creative problem-solving, and the presentation of actionable recommendations to clients.
• Identify and address training needs, developing and conducting training sessions or in-service programs as requested by clients to enhance staff competency and performance.
• Operate within the defined scope of work, maintaining strict adherence to client agreements and expectations.
• Uphold client confidentiality and ensure full compliance with HIPAA regulations, safeguarding sensitive information throughout the engagement.

Minimum Qualifications:

• Bachelor’s degree in nursing from an accredited college or university, with at least five (5) years of clinical experience, including 3+ years specializing in the RAI process.
• Current and unrestricted RN ,along with active RAC-CT certification, ensuring adherence to industry standards and best practices.
• Possesses exceptional critical thinking skills, with the proven ability to make informed decisions, demonstrate sound clinical judgment, and apply expert knowledge in quality improvement concepts and processes.
• Demonstrates strong leadership abilities and excels in interpersonal communication, fostering collaboration, and guiding teams to achieve optimal clinical outcomes.

Key Rehab is an equal opportunity employer/service provider.

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