MDS Specialist RN

About the role

The Lead MDS/Clinical Reimbursement Coordinator will oversee the timely and accurate completion of the Minimum Data Set (MDS) and Care Area Assessments (CAAs) in compliance with CMS regulations. They will also strategize ARDs and audits to optimize PDPM components, nursing tiers, and NTA scores. This position involves analyzing quality measures and Five-Star ratings, overseeing interdisciplinary care planning, leading utilization review and triple-check meetings, and systematically auditing clinical records.

Responsibilities

• MDS/RAI Process Leadership: Direct the timely and accurate completion of MDS and CAA assessments.
• PDPM & Reimbursement Strategy: Schedule ARDs and audits to capture true resident acuity, optimize PDPM components, nursing tiers, and NTA scores.
• Quality Measure & Five-Star Optimization: Analyze Casper reports and collaborate with the DON/IDT to monitor clinical triggers, drive root-cause corrections, and safeguard the facility's Five-Star rating.
• Interdisciplinary Care Planning: Oversee the development of individualized resident Care Plans that support MDS coding, establish clear goals, and satisfy all regulatory requirements.
• Utilization Review & Triple-Check Coordination: Lead weekly UR and Triple-Check meetings, validate medical necessity, track managed care authorizations, and ensure accurate billing alignment.
• Audit Readiness & Compliance: Systematically audit clinical records to defend data integrity against ADRs, MAC/RAC audits, and pre-payment reviews.
• IDT Collaboration & Care Meetings: Facilitate interdisciplinary meetings to ensure seamless care integration and reimbursement alignment.

Requirements

• Licensure: Current, unrestricted Registered Nurse (RN) license in the state of practice.
• MDS Experience: 1–3 years of dedicated MDS experience preferred; or experienced LTC RN with strong clinical and analytical skills who can be trained.
• Regulatory Expertise: Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term care regulations.
• Clinical Knowledge: Strong understanding of general, rehabilitative, and restorative nursing practices, including comprehensive care planning.
• Software Proficiency: Skilled in Microsoft Windows applications; experience with PointClickCare (PCC) and NetHealth is highly preferred.
• Operational Skills: Exceptional attention to detail with a proven ability to complete assessments accurately and within strict regulatory deadlines.
• Autonomy & Flexibility: Ability to work independently and adjust scheduling to support crucial month-end financial close procedures.

Qualifications

Preferred qualifications include:

• Experience with PDPM and reimbursement strategies.
• Strong collaboration and communication skills.
• Ability to manage multiple tasks and meet strict deadlines.

Skills

• Excellent organizational and time management skills.
• Strong analytical and problem-solving abilities.
• Proficient in Microsoft Office applications.
• Experience with PointClickCare (PCC) and NetHealth.

Benefits

Part-time (22.5+ hours/week) and Full-time Employees at CareOne at Madison enjoy a comprehensive benefits package including:

• Comprehensive Healthcare Benefits
• Multiple Medical Plans Including Pharmacy
• Teladoc
• Multiple Dental Plans
• Vision Plan
• Health Savings Account (HSA)
• Flexible Spending Accounts
• Voluntary Life and AD&D
• Short-Term and Long-Term Disability Plans
• Hospital Indemnity Insurance
• Critical Illness Insurance
• Accident Insurance
• Whole Life Insurance
• Medicare Employee Assistance Plan
• Legal Plan
• Commute Benefits
• 401(k) Retirement Plan
• Employee Assistance Program (EAP)
• Paid Time Off (PTO)
• Vacation
• Sick

Pay

$83,000 to $120,000

Schedule

Part-time (22.5+ hours/week) and Full-time positions available.