Clinical MDS Account Manager - US at Limitlessli

At Limitlessli, we specialize in recruiting, hiring, and managing high-caliber remote staff for dynamic and growing healthcare facilities. Leveraging our extensive global network, we connect clients with highly qualified professionals, offering tailored services to meet our clients' unique business needs.

The Opportunity:

We are seeking a highly motivated and detail-oriented Licensed Practical Nurse (LPN) with strong experience in MDS coordination, Managed care, and Triple check processes. The Clinical MDS Account Manager will be responsible for coordinating patient care, ensuring compliance with regulatory guidelines, and supporting reimbursement accuracy through effective utilization of managed care resources. This role requires strong clinical judgment, excellent communication skills, and the ability to collaborate across interdisciplinary teams.

This position is remote and offers you the flexibility of working from home.

Key Responsibilities:

• Along side the SVP of Clinical Reimbursement, 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.

Qualifications:

• Current Licensed Practical Nurse (LPN) in good standing [State-specific license required].
• The ideal candidate will have experience working with multiple clients.
• 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.

Preferred Skills

• Prior experience in long-term care, skilled nursing, or rehabilitation settings.
• Working knowledge of Medicare/Medicaid reimbursement guidelines.
• Certification in Case Management (CCM or ACM) a plus, but not required.

Service Fee:

Industry standards applicable to the state depending on work experience and level of expertise.

Hours:

Philippines Time – Monday to Friday, 8am to 6pm

Why Limitlessli?

We embrace the flexibility and convenience of a remote working environment, and you will collaborate with an international team while contributing to our growing business, all from the comfort of your home.

Essential requirements:

You will need to have some essential tools – a reliable computer and noise-cancelling headset, a second monitor for enhanced productivity, and a stable internet connection. You’ll also be required to have a backup internet connection, ensuring that you’re well-equipped to complete your work seamlessly.

Don't miss out on this opportunity – apply now and become a valuable member of the Limitlessli team! If you're interested in what you have read, then we invite you to take the next step and submit your application.

JOIN OUR TEAM!!