MDS Nurse (RN or LPN)
Salaried: $66,560 - $74,880 annually (depending on license or experience)
Equivalent Hourly: $32 - $36
Shift: Full-Time
Schedule: Monday- Friday, Flexible schedule
Northgate Health Care Facility is looking to add an MDS Nurse to its team. In this role, you’ll support Medicare, Managed Care, and Medicaid reimbursement processes while helping ensure accurate MDS completion, regulatory compliance, and reimbursement optimization. If you have experience with MDS, PDPM, and long-term care reimbursement, this could be the perfect opportunity for you.
Located in North Tonawanda, NY, Northgate Health Care Facility is proud to be part of The McGuire Group, a recognized leader in skilled nursing, rehabilitation, and long-term care services throughout New York State. Recognized with a CMS 4-Star Overall Rating, Northgate is committed to delivering high-quality care while fostering a supportive and team-oriented workplace. Our employees are empowered to grow professionally, build meaningful relationships with residents, and make a positive impact every day. Join a team where compassion, collaboration, and excellence are at the heart of what we do.
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
- Monitor reimbursement compliance and establish systems to address areas of non-compliance
- 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
- Complete PDPM reviews upon admission, re-admission, or as indicated
- Review Medicare Part A MDS assessments for accuracy and compliance
- 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
REQUIREMENTS:
- Minimum experience requirement: 2 years of long-term care experience; 4 years of long-term care experience preferred
- Current unrestricted NYS Licensed Practical Nurse (LPN) License OR Registered Nurse (RN) 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
- Strong communication and interpersonal abilities
- Ability to manage multiple priorities and meet deadlines
- Knowledge of long-term care regulations, reimbursement methodologies, and standards of care
- Ability to provide education, training, and support to interdisciplinary teams
BENEFITS:
- Paid Time Off (PTO) for Full-Time and Part-Time
- Weekly or Same-Day Pay Options
- Health, Dental, and Vision Insurance
- Life Insurance
- Employee Referral Bonus Program
- Retirement Saving Options