Medical Review Nurse - SNF/MDS Auditor

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 2 hours agoStatus: Live

Job Summary

Role focuses on remote SNF medical claims audit reviews, applying MDS/RAI guidelines to ensure medically appropriate services, and preparing audit documentation. You will collaborate with an audit team, assist with appeals, and help refine medical policies and system edits while staying current on regulatory changes in healthcare claims auditing.

Location: United States

Workplace: Remote

Employment Type: Full time

Job Function: Healthcare (Clinical, Medical, Wellness)

Key Responsibilities

•Audit claims for medically appropriate services provided in skilled nursing facility settings while applying appropriate medical review guidelines, policies and rules.
•Document all findings referencing the appropriate policies and rules.
•Generate letters articulating audit findings.
•Support audit findings during the appeals process if requested.
•Work collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse.

Key Requirements

•Active unrestricted RN license in good standing
•Minimum of five (5) years diversified nursing experience providing direct care in an inpatient or outpatient setting
•One (1) or more years’ experience with MDS/ RAI process
•One (1) or more years' experience performing medical records review
•One (1) or more years' experience in health care claims that demonstrates expertise in ICD-9/ICD-10 coding guidelines and how it relates to the MDS RAI Process

Experience:HealthcareNursingMDSRAIICD-9ICD-10

Skills:CommunicationMultitaskingOrganizationTime managementAttention to detail

Licenses:RN license

Languages:English

Tech Stack:Microsoft OfficeWordExcelPowerPointICD-9ICD-10MDSRAIPDPMUB-04

Company Brief

Machinify

Provides AI-driven predictive maintenance and asset-monitoring solutions for manufacturing and industrial operations, using IoT sensor data and machine learning to reduce downtime, optimize performance, and extend equipment life.

Industry: Industrial Automation

Website

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Machinify

1 month ago

Medical Review Nurse - SNF/MDS Auditor

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 2 hours agoStatus: Live

Job Summary

Location: United States

Workplace: Remote

Employment Type: Full time

Job Function: Healthcare (Clinical, Medical, Wellness)

Key Responsibilities

•Audit claims for medically appropriate services provided in skilled nursing facility settings while applying appropriate medical review guidelines, policies and rules.
•Document all findings referencing the appropriate policies and rules.
•Generate letters articulating audit findings.
•Support audit findings during the appeals process if requested.
•Work collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse.

Key Requirements

•Active unrestricted RN license in good standing
•Minimum of five (5) years diversified nursing experience providing direct care in an inpatient or outpatient setting
•One (1) or more years’ experience with MDS/ RAI process
•One (1) or more years' experience performing medical records review
•One (1) or more years' experience in health care claims that demonstrates expertise in ICD-9/ICD-10 coding guidelines and how it relates to the MDS RAI Process

Experience:HealthcareNursingMDSRAIICD-9ICD-10

Skills:CommunicationMultitaskingOrganizationTime managementAttention to detail

Licenses:RN license

Languages:English

Tech Stack:Microsoft OfficeWordExcelPowerPointICD-9ICD-10MDSRAIPDPMUB-04

Company Brief

Machinify

Industry: Industrial Automation

Website