MDS Lead RN

The McGuire Group•Cheektowaga, NY

12d•Onsite

About The Position

Garden Gate Health Care Facility is seeking an MDS Lead RN to coordinate Medicare, Managed Care, and Medicaid reimbursement activities while ensuring accurate MDS completion, regulatory compliance, and reimbursement optimization. The role provides education and support to facility staff, oversees MDS processes, and assists with reimbursement-related audits and reviews. The position is based in Cheektowaga, New York, at a skilled nursing, rehabilitation, and long-term care facility that is part of The McGuire Group.

Requirements

Associate's Degree in Nursing required; Bachelor's Degree in Nursing preferred.
At least 2 years of long-term care experience required; 4 years preferred.
Current unrestricted New York State Registered Nurse (RN) license required.
Experience with MDS, PDPM, reimbursement, and quality measures.
Strong understanding of Medicare, Medicaid, Managed Care, and third-party payer requirements.
Excellent time management, organizational, and problem-solving skills.
Proven leadership skills and ability to mentor and support team members.
Strong communication and interpersonal abilities.
Ability to manage multiple priorities and meet deadlines.
In-depth knowledge of long-term care regulations, reimbursement methodologies, and standards of care.
Ability to provide education, training, and support to interdisciplinary teams.

Nice To Haves

Bachelor's Degree in Nursing.
4 years of long-term care experience.

Responsibilities

Provide education and support to facility staff regarding Medicare, Medicaid, Managed Care, eligibility, certification, coverage, documentation, utilization, and reimbursement.
Assist facilities with certification procedures, reimbursement-related processes, and resolution of problem areas.
Collaborate with claims review units, compliance teams, and third-party payers to ensure regulatory and company compliance.
Assist with the review and preparation of denied claims, audits, and administrative record reviews.
Assess compliance with Medicare, Medicaid, Managed Care, and third-party payer requirements and develop corrective action plans as needed.
Maintain and analyze reimbursement-related statistical data and utilization trends.
Monitor authorizations and compliance with third-party payer requirements.
Provide ongoing education and training related to reimbursement programs and regulatory changes.
Conduct PDPM reviews upon admission, re-admission, or as indicated.
Review Medicare Part A MDS assessments for accuracy and compliance.
Supervise MDS LPN activities and co-sign MDS assessments completed by LPN staff as required.
Gather documentation for CMS audits and other reimbursement-related audits.
Review physician documentation and assist with accurate ICD-10 coding and diagnosis ranking.
Conduct MDS integrity reviews and complete MDS assessments as needed.
Perform additional duties as assigned.