Nurse Jobs

About The Position

Requirements

• One or more years of applicable experience as described in the job duties
• Licensure as a Registered Nurse issued by the Nevada State Board of Nursing.

Nice To Haves

• Certification in auditing skilled nursing facilities using the Minimum Data Set potentially required within the first year.

Responsibilities

• Assess potential client needs for case management services.
• Develop, implement, and update plans of care.
• Counsel and refer clients to services and/or contract with providers for services.
• Monitor the quality and cost of services provided and submit payment authorization requests.
• Establish and maintain case files.
• Review facilities, provide care to validate, and ensure adequacy of services and resident care.
• Review information, document findings and deficiencies, prepare reports, and participate in conferences.
• Review health care providers and fiscal agents for compliance.
• Ensure clients are receiving appropriate services and payment is correct for services received.
• Identify areas needing improvement and review plans of correction.
• Process payment requests to ensure medical necessity and compliance and approve or deny requests.
• Review records from the applicable parties, identify abuse and potential fraud, and ensure proper payment.
• Refer errors to the fiscal agent for adjustment and refer potential cases of fraud and abuse for investigation.
• Explain billing procedures, monitor quality of care, and submit billings to the fiscal agent for payment.
• Perform related duties as assigned.