Medical Review Nurse II - SNF/MDS Auditor

About the Role:

• Perform retrospective and prepayment audits on skilled nursing facility (SNF) claims for government and commercial payers.
• Work remotely in a fast-paced, dynamic environment as part of a multi-location team.

Key Responsibilities:

• Audit claims for medically appropriate services in SNF settings, applying medical review guidelines and policies.
• Document findings, generate audit letters, and support appeals when necessary.
• Collaborate with clients, CMD colleagues, and contractors on medical policies, provider education, and system edits.

Qualifications:

• Active unrestricted RN license in good standing with five or more years of diversified nursing experience.
• One or more years of MDS/RAI process experience and medical records review experience.
• Deep knowledge of ICD-9/ICD-10, HCPCS coding, and PDPM payment items.

Work Environment:

• Remote position with a collaborative, multi-location audit team.
• Must independently manage assignments and effectively use Microsoft Office tools.