Regional Reimbursement Nurse Consultant

Regional MDS / PDPM / CMI / RAI Consultant

We are seeking an experienced Regional MDS / PDPM / CMI / RAI Consultant to provide remote reimbursement, MDS, PDPM, Case Mix Index, and RAI support to our long-term care and skilled nursing facilities.

This position will provide regional oversight to ensure accurate MDS completion, proper PDPM classification, optimized reimbursement, accurate case mix, regulatory compliance, and strong interdisciplinary team processes. Quarterly travel to assigned facilities will be required for on-site audits, training, clinical reimbursement review, and team support.

This role is ideal for a highly organized MDS professional with strong knowledge of PDPM, RAI guidelines, CMI, care planning, Medicare documentation, and long-term care reimbursement systems.

Key Responsibilities

• Provide regional oversight for MDS, PDPM, CMI, and RAI processes
• Monitor timely and accurate MDS completion across assigned facilities
• Review PDPM classifications, clinical documentation, diagnosis coding, and reimbursement accuracy
• Support Case Mix Index improvement through accurate assessment and documentation
• Audit MDS assessments for accuracy, compliance, and missed reimbursement opportunities
• Review Medicare Part A documentation and skilled coverage support
• Assist with Triple Check and Medicare meetings
• Support facility MDS Coordinators, DONs, Administrators, and interdisciplinary teams
• Review care plans for accuracy and alignment with MDS assessments
• Monitor ARD schedules, assessment calendars, significant change assessments, and discharge assessments
• Provide education and coaching to facility MDS and clinical teams
• Assist with RAI Manual interpretation and regulatory compliance
• Identify trends, risks, late assessments, coding errors, and reimbursement concerns
• Participate in monthly or quarterly reimbursement reviews with regional leadership
• Travel quarterly to assigned facilities for audits, training, and operational support

Qualifications

• Active RN license required
• Long-term care/skilled nursing experience required
• MDS experience required
• Strong knowledge of PDPM, RAI, CMI, Medicare, and Medicaid case mix processes
• Experience with multi-facility MDS oversight preferred
• RAC-CT certification preferred
• Experience with Triple Check, Medicare meetings, care planning, and reimbursement audits preferred
• Strong understanding of RAI Manual requirements
• Ability to work independently from home
• Strong communication, organization, auditing, and follow-through skills
• Ability to travel quarterly to assigned facilities
• Experience with PCC or similar electronic health record system preferred

Compensation & Benefits

• Competitive salary or hourly rate
• Primarily remote/work-from-home position
• Quarterly travel reimbursement
• Mileage reimbursement
• Lodging and meal reimbursement when overnight travel is required
• Licensure or certification reimbursement as approved
• Opportunity to support multiple facilities and directly impact reimbursement accuracy, compliance, and clinical outcomes