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Tikva Healthcare
Regional MDS
Career Insights for Clinical Auditor / Utilization Reviewer
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What they do
A Clinical Auditor or Utilization Reviewer reviews the efficiency of healthcare delivery. Individuals tend to have had experience as a registered nurse or other healthcare delivery roles before transferring into this quality review role.
$94,930 / year median in Texas
-3% projected decline
Job Description
Regional MDS Tikva Healthcare Dallas, TX Job Details Full-time $80,000 - $100,000 a year 1 hour ago Benefits Travel reimbursement Health insurance Dental insurance Paid time off Vision insurance Life insurance Qualifications Anatomy knowledge Medicare Nursing home experience Clinical documentation Health information management Full Job Description Job Summary We are seeking a dynamic and detail-oriented Regional MDS (Minimum Data Set) Director to lead and coordinate comprehensive resident assessments across multiple healthcare facilities within our region. This vital role ensures compliance with federal and state regulations, enhances clinical documentation accuracy, and promotes optimal patient care outcomes. The Regional MDS Coordinator will serve as a key liaison among interdisciplinary teams, managed care organizations, and regulatory bodies, driving quality improvement initiatives and ensuring adherence to Medicare, Medicaid, and long-term care standards. This position offers an exciting opportunity to influence clinical practices on a regional scale while supporting the delivery of exceptional patient-centered care. Duties Oversee the development, review, and completion of MDS assessments in accordance with CMS (Centers for Medicare and Medicaid Services) regulations, ensuring timely submission and accuracy. Collaborate with nursing staff, physicians, social workers, and other healthcare professionals to gather comprehensive clinical documentation aligned with clinical documentation standards. Conduct thorough documentation reviews to identify gaps in medical records, optimize coding accuracy including ), ICD-10 (International Classification of Diseases),, and ensure compliance with HIPAA and health regulation policies. Lead utilization management efforts by analyzing patient data to support appropriate level of care decisions, discharge planning, and case management strategies for long-term care, hospice, acute care, and inpatient settings. Provide training and ongoing education to staff on EMR/EHR systems such as PCC, and iQies. CMS regulations through regular audits of medical records and documentation review processes. Skills Extensive knowledge of PCC and other electronic health record platforms. Extensive knowledge of PDPM reimbursement and State Medicaid reimbursement. Strong understanding of managed care processes including Medicare/Medicaid regulations and long-term care policies. Experience in Long Term Care Nursing. Proficiency in medical documentation review techniques. Familiarity with healthcare regulation policies such as