PDPM Clinical Resource Nurse (RN or LPN)
About The Position
Cascadia Healthcare is seeking an experienced and relationship-focused PDPM Clinical Resource Nurses (RN or LPN) to support their skilled nursing facilities. This role involves serving as a clinical and reimbursement resource to help facility teams understand and apply the Patient-Driven Payment Model (PDPM), ensuring accurate, compliant, and clinically supported reimbursement practices. The ideal candidate possesses strong MDS knowledge, a passion for the financial and reimbursement aspects of skilled nursing, and the ability to educate, coach, and influence teams through collaboration. Success requires balancing reimbursement optimization, regulatory compliance, and strong partnerships with facility leadership. This position is suited for individuals who enjoy analyzing clinical documentation, identifying reimbursement opportunities, educating teams, and guiding facilities through complex PDPM requirements.
Requirements
- Active RN or LPN license.
- Strong knowledge of MDS assessment processes and PDPM reimbursement methodology.
- Experience in skilled nursing, long-term care, or post-acute care settings.
- Excellent interpersonal, verbal, written, and presentation skills.
- Ability to build relationships and effectively influence diverse teams.
- Strong organizational skills and ability to work independently.
- Previous experience as an MDS Coordinator, Clinical Reimbursement Specialist, Clinical Resource Nurse, or Regional MDS/PDPM Consultant.
- Multi-facility oversight, management, or regional support experience.
- Experience conducting audits, reimbursement reviews, or clinical documentation improvement initiatives.
- Demonstrated success training and mentoring clinical teams.
- Strong understanding of Medicare reimbursement and regulatory compliance.
Responsibilities
- Serve as a regional subject matter expert on PDPM reimbursement, MDS coding, and Medicare payment methodologies.
- Perform clinical and reimbursement reviews to identify opportunities for accurate PDPM capture and appropriate reimbursement.
- Analyze resident documentation, MDS assessments, and supporting clinical records to ensure coding accurately reflects resident conditions and services provided.
- Assist facilities in understanding reimbursement implications of MDS coding decisions while supporting facility autonomy in final coding determinations.
- Monitor reimbursement trends and identify opportunities for process improvement and revenue integrity.
- Conduct facility audits to evaluate MDS accuracy, supporting documentation, and PDPM performance.
- Provide objective feedback and recommendations that promote compliance, clinical accuracy, and reimbursement integrity.
- Partner with facility leadership to address documentation gaps and strengthen coding practices.
- Ensure recommendations align with CMS regulations, state requirements, and ethical reimbursement practices.
- Support facilities in maintaining audit readiness and regulatory compliance.
- Develop strong relationships with MDS Coordinators, DONs, Administrators, and interdisciplinary teams.
- Deliver ongoing education regarding PDPM, MDS coding, documentation requirements, and reimbursement best practices.
- Provide individualized coaching and mentorship to facility teams to increase knowledge, confidence, and consistency.
- Translate complex reimbursement concepts into practical, understandable guidance for clinical staff and leaders.
- Serve as a trusted resource for questions related to PDPM, Medicare reimbursement, and clinical documentation practices.
- Collaborate with regional and facility leadership to support clinical and financial goals.
- Participate in reimbursement reviews, operational meetings, and strategic initiatives.
- Assist with onboarding and training of new MDS and reimbursement personnel.
- Maintain flexibility to travel throughout the region and provide onsite support as needed.
- Manage priorities independently while adapting to changing facility and organizational needs.
Benefits
- Competitive Salary (depending on experience)
- Medical, dental, and vision benefits
- Paid time off, sick and vacation days
- Life insurance
- 401(k) retirement plan
- Short-term and long-term disability coverage
- Employee Assistance Program (EAP)
- Professional Development Opportunities
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
