Clinical MDS Account Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Maintain client relationships, engage in communication, and provide reporting for designated clients.

• Coordinate and supervise patient care plans in partnership with physicians, therapists, and nursing personnel.

• Oversee MDS (Minimum Data Set) assessments to guarantee timely and precise submissions in line with federal and state regulations.

• Review, monitor, and manage managed care authorizations, ensuring that patients receive suitable and authorized services.

• Engage in triple check procedures to confirm the accuracy of billing, coding, and clinical documentation.

• Regularly communicate with insurance providers, patients, and families concerning care plans and coverage.

• Monitor patient progress, outcomes, and transitions of care to minimize readmissions and enhance quality of care.

• Ensure compliance with regulatory standards, company policies, and professional guidelines.

• Act as a resource for staff education and training related to managed care, MDS, and documentation standards.

• Assist with audits, reporting, and quality assurance efforts.

⛳️ Requirements

• Must possess a current Licensed Practical Nurse (LPN) license in good standing [State-specific license required].

• A minimum of 2+ years of experience in case management, utilization review, or a related nursing position.

• Practical experience with MDS assessments and familiarity with CMS guidelines.

• Understanding and previous experience in managed care processes and insurance authorizations.

• Knowledge of the triple check process for billing and reimbursement.

• Excellent organizational, communication, and problem-solving abilities.

• Capability to work both independently and collaboratively in a fast-paced healthcare setting.

• Proficient in electronic medical records (EMR) systems and the Microsoft Office Suite.

🏝️ Benefits

• Flexible working arrangements

• Work from home options