Clinical Reimbursement Consultant

Experience the Positive, Innovative, and Flexible Culture at Pathway Health Services!

At Pathway Health Services, we believe in working hard and having fun. Our positive culture fosters an environment where innovation thrives, and we empower our team to think outside the box and develop creative solutions to challenges. With flexibility at the core of what we do, we adapt to change seamlessly by delivering the best possible service to our clients.

We're looking for experienced Registered Nurses (RNs) interested in exciting travel interim leadership opportunities! As a Nurse Consultant, you'll provide on-site professional consulting services to post-acute and aging services clients, making a real impact in organizations that need your expertise.

The Clinical Reimbursement Consultant provides clinical and reimbursement support, conducts audits, analyzes reimbursement trends, and educates facility staff on best practices related to Medicare, Medicaid, Managed Care, and other payer sources.

Responsibilities:

• Assist the client with assessing, planning, developing, and implementing systems, processes, and other needs as requested.
• Assist the client with clinical reimbursement systems and training.
• Training for MDS 3.0 Basics course,CAAs, care planning, PDPM, and Quality Measures.
• Maintain current working knowledge of applicable state and federal standards, regulations, and industry standards of practice.
• Identify training needs; plan and conduct training/in-services as requested.
• Assist clients as requested in the selection and hiring of key management staff.
• Participate in/conduct comprehensive quality assessments as requested.
• Maintain client confidentiality and function within HIPAA regulations.
• Travel throughout the state or states licensed in.

Qualifications:

• RN license.
• RAC-CT is required, RAC-CTA preferred.
• Comprehensive knowledge of the full clinical reimbursement process within skilled nursing and long-term care settings.
• Extensive understanding of Medicare, Medicaid, Managed Care, and other payer reimbursement methodologies.
• Strong working knowledge of MDS assessment processes, reimbursement systems, case mix management, and reimbursement optimization strategies.
• Experience with Patient-Driven Payment Model (PDPM), Case Mix Groups (CMGs), and Care Area Assessments (CAAs).
• Ability to interpret and apply federal and state reimbursement regulations while ensuring compliance and maximizing reimbursement opportunities.
• Proficiency in reviewing clinical documentation to support accurate coding, assessment completion, and reimbursement outcomes.

Special Position Requirements:

• Must maintain all required professional licenses and certifications if applicable.
• Provide proof of current and in good standing licensure if applicable.
• Must maintain an active driver's license and provide proof of auto insurance upon request.

What We Offer:

Our benefits are designed to support your health, financial security, and work-life balance while providing a fun and continuous learning environment!

Eligible employees may enjoy a comprehensive benefits package that can include:

• 401(k) Retirement Plan- Plan for your future with company-supported contributions.
• Paid Time Off- Vacation and sick leave to recharge and handle personal matters.
• Medical Premium Reimbursement- Support for health insurance costs.
• Dental Coverage - Optional dental plans to keep your smile healthy.
• Ancillary Benefits - Additional products and perks, such as vision coverage, life insurance, and wellness programs.

Pathway Health is an independently owned, nationally recognized consulting company that provides expert services to long-term healthcare, senior housing, assisted living, home care, and hospice organizations.

Join us at Pathway Health and experience a workplace that values your unique contributions and supports your growth.

Pathway Health is an EEO/AAP Employer.