MDS Case Manager

Overview
Join our dynamic healthcare team as an MDS (Minimum Data Set) Case Manager, where you will play a vital role in coordinating comprehensive patient assessments and ensuring optimal care planning within skilled nursing facilities, rehabilitation centers, or other inpatient settings. This energetic position offers the opportunity to utilize your clinical expertise and case management skills to improve patient outcomes, streamline documentation, and support interdisciplinary teams. You will be at the forefront of clinical documentation improvement, utilization review, and compliance with healthcare standards, making a meaningful difference in patient care delivery.

Responsibilities

• Conduct thorough MDS assessments to evaluate patient needs, ensuring accurate and timely completion in accordance with CMS (Centers for Medicare & Medicaid Services) guidelines and NCQA standards.
• Collaborate with nursing staff, physicians, therapists, and other healthcare professionals to develop individualized care plans that meet regulatory requirements and promote optimal recovery.
• Review medical records, documentation, and clinical data to ensure accuracy, completeness, and compliance with HIPAA regulations and medical coding standards such as ICD-10, CPT coding, DRG assignments, and ICD-9.
• Perform utilization management activities by analyzing patient acuity levels, discharge planning needs, and appropriate resource utilization in inpatient or outpatient settings.
• Support clinical documentation improvement initiatives by identifying gaps in records related to physiology knowledge, anatomy knowledge, and medical terminology.
• Utilize EMR (Electronic Medical Record) systems such as Epic, Cerner, Athenahealth or eClinicalWorks to document assessments and communicate findings effectively across teams.
• Assist with discharge planning processes including hospice care coordination or transitions from acute care units like ICU or PICU to home care or other facilities.

Qualifications

• Proven experience in managed care environments with a strong background in inpatient or outpatient clinical settings; Long-Term Care and Skilled Nursing/ Short-Term Care Rehabilitation experience is highly desirable.
• Demonstrated expertise in medical office procedures, hospital workflows, and familiarity with EMR/EHR systems.
• In-depth knowledge of medical terminology, anatomy, physiology, ICD coding (ICD-10/ICD-9), CPT coding, DRG assignments, and Medicare regulations.
• Strong understanding of utilization review processes including utilization management and clinical documentation improvement strategies.
• Prior experience working within nursing homes or skilled nursing facilities is preferred; experience with discharge planning or hospice care is a plus.
• Excellent communication skills with the ability to review medical records thoroughly while maintaining HIPAA compliance.
• Nursing licensure or RAC certifications are preferred. Join us in delivering exceptional patient-centered care through meticulous assessment coordination and comprehensive documentation review! Your expertise will help shape better health outcomes while advancing your career in a vibrant healthcare environment committed to excellence.

Pay: $90,000.00 - $110,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Flexible spending account
• Free parking
• Health insurance
• Paid time off
• Professional development assistance
• Referral program
• Tuition reimbursement
• Vision insurance

License/Certification:

• RAC-CT (Preferred)

Ability to Commute:

• Sauk City, WI 53583 (Preferred)

Work Location: Hybrid remote in Sauk City, WI 53583