Clinical Reimbursement Auditing Nurse

Engage Consulting
Toledo, OH
Description

Clinical Reimbursement Auditing Nurse – Remote

Full-Time | Remote | Compact Nursing License Required

We are seeking a highly skilled Clinical Reimbursement Auditing Nurse to join our team in a fully remote capacity. The ideal candidate will have strong attention to detail, in-depth knowledge of the Patient-Driven Payment Model (PDPM) , and proven experience in conducting Case Mix and accuracy reviews . This role requires an analytical professional who can ensure compliance, optimize reimbursement, and provide expert auditing across multiple states.

Key Responsibilities

  • Perform PDPM accuracy and opportunity reviews to ensure compliance and maximize reimbursement.
  • Conduct Case Mix audits and validate data integrity across multiple facilities.
  • Analyze MDS submissions for accuracy, consistency, and compliance.
  • Collaborate with facility staff to provide feedback, education, and recommendations.
  • Identify trends and assist in developing corrective action plans when necessary.
  • Maintain up-to-date knowledge of CMS regulations and reimbursement guidelines.

Qualifications

  • Active Compact RN License required.
  • Minimum 2 years of MDS/Clinical Reimbursement experience in a skilled nursing facility setting.
  • Strong working knowledge of PDPM, Case Mix, and Medicare/Medicaid guidelines.
  • Multi-state reimbursement experience strongly preferred.
  • Excellent attention to detail, organizational skills, and ability to meet deadlines.
  • Proficient in electronic medical record (EMR) and MDS software.

What We Offer

  • Fully remote role with flexible scheduling.
  • Competitive compensation package.
  • Opportunities for professional growth and continuing education.
  • Supportive and collaborative work environment.
Posted 2025-09-20

Recommended Jobs

MOBILE SERVICE TECHNICIAN

Worldwide Equipment Enterprises Inc
Dayton, OH

Job Description Job Description POSITION SUMMARY A Mobile Service Technician performs repairs And / Or maintenance on Heavy and Medium Duty vehicles at various locations away from the dealer…

View Details
Posted 2025-07-26

Home Visitor

Miami Valley Child Development Centers
Springfield, OH

Summary   About Us: Miami Valley Child Development Centers is southwest Ohio's Head Start Agency. For over 55 years, we've been providing  FREE  early learning and childcare to children from 6 …

View Details
Posted 2025-09-16

Customer Support Representative

Refresh Refinishing
Akron, OH

Who We Are Refresh provides services to the Multi-family industry, helping large management companies get apartment units ready for a new tenant to move in. Services include bath refinishing, ca…

View Details
Posted 2025-09-22

Network Administrator

Greater Cincinnati Behavioral Health Services
Cincinnati, OH

Job Description Job Description Greater Cincinnati Behavioral Health Services (GCBHS) is seeking a Network Administrator to ensure the effective operation of the organization’s network devices.…

View Details
Posted 2025-07-28

Physical Therapist, Part Time

Patriot At Home
Cincinnati, OH

Job Description Job Description Salary: Homecare Physical Therapist Territory: 30 mile radius of Amelia Ohio Business Hours: Monday - Friday, 8:00 AM to 4:30 PM Patriot is veteran own…

View Details
Posted 2025-09-06

Hospital | Rad Tech

Euclid, OH

Travel Radiologic Technologist - Angiography in Cleveland, OH Travel Radiologic Technologist - Angiography Join our healthcare team as a Travel Radiologic Technologist specializing in Angiography …

View Details
Posted 2025-07-31

Direct Support Professional- Day Program

BrightSpring Health Services
Fairfield, OH

Job Description Job Description Overview ResCare Community Living – Direct Support Professional Thank you for reviewing our Direct Support Professional position at ResCare Community Livin…

View Details
Posted 2025-08-18

Lawn Maintenance Crew Member

Green Impressions Landscaping
Sheffield Village, OH

Green Impressions Landscaping is a growing company dedicated to creating and maintaining beautiful outdoor spaces for our clients. As a Lawn Maintenance Crew Member, you will play a key role in deliv…

View Details
Posted 2025-09-16

Controller POST NUMBER: 436958

Columbus, OH

Controller ~ Columbus, OH ~$50 – 65 per hour ~ Consulting, possibly consult-to-hire We are seeking an experienced Controller consultant to oversee accounting operations, including month-…

View Details
Posted 2025-08-24

Business Immigration Associate Attorney

UB Greensfelder LLP
Cincinnati, OH

UB Greensfelder currently has an opening for an Associate Attorney with 3+ years of experience to join the Immigration Practice Group, working in our Illinois, Ohio, Missouri or New York offices. Curr…

View Details
Posted 2025-09-11