Clinical MDS Account Manager

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Limitlessli

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

🎯 Recruiter

☁️ SaaS

Healthcare Insurance • Recruitment • SaaS

Limitlessli is a company that specializes in providing offsite staffing solutions for healthcare facilities. They offer customized staffing services for clinical and non-clinical roles, aiming to reduce operational costs and enhance efficiency. With a focus on remote staffing, Limitlessli supports healthcare operations by ensuring compliance with CMS, DOH, and other regulatory agencies through their Active Review Protocols (ARPs™). They provide MDS consulting services and cater to a wide array of healthcare settings including skilled nursing facilities, home healthcare, urgent care centers, and telehealth, among others. Their solutions are designed to increase ROI, offer scalable staffing options, and minimize stress for their clients.

📋 Description

• Hold the client relationship, communication and reporting for assigned clients. • Coordinate and oversee patient care plans in collaboration with physicians, therapists, and nursing staff. • Manage MDS (Minimum Data Set) assessments to ensure timely and accurate submission in accordance with federal and state regulations. • Review, monitor, and manage managed care authorizations, ensuring patients receive appropriate and approved services. • Participate in triple check processes to ensure accuracy of billing, coding, and clinical documentation. • Communicate regularly with insurance providers, patients, and families regarding care plans and coverage. • Monitor patient progress, outcomes, and transitions of care to reduce readmissions and optimize quality of care. • Maintain compliance with regulatory requirements, company policies, and professional standards. • Serve as a resource for staff education and training related to managed care, MDS, and documentation standards. • Assist with audits, reporting, and quality assurance initiatives.

🎯 Requirements

• Current Licensed Practical Nurse (LPN) in good standing [State-specific license required]. • Minimum of 2+ years of experience in case management, utilization review, or related nursing role. • Hands-on experience with MDS assessments and knowledge of CMS guidelines. • Knowledge and prior experience in managed care processes and insurance authorizations. • Familiarity with triple check process for billing and reimbursement. • Strong organizational, communication, and problem-solving skills. • Ability to work independently and collaboratively in a fast-paced healthcare environment. • Proficient in electronic medical records (EMR) systems and Microsoft Office Suite.

🏖️ Benefits

• Flexible working arrangements • Work from home options