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 audit clinical documentation to optimize PDPM components, nursing tiers, and NTA scores. This position involves analyzing Casper reports, facilitating interdisciplinary meetings, and leading Utilization Review (UR) and Triple-Check meetings.

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 resident acuity and optimize reimbursement strategies.
• Quality Measure & Five-Star Optimization: Analyze Casper reports and collaborate with DON/IDT to improve Five-Star ratings.
• Interdisciplinary Care Planning: Develop and implement individualized resident Care Plans.
• Utilization Review & Triple-Check Coordination: Lead UR and Triple-Check meetings, ensuring accurate billing and alignment with managed care authorizations.
• Audit Readiness & Compliance: Systematically audit clinical records to ensure data integrity.
• IDT Collaboration & Care Meetings: Facilitate interdisciplinary meetings to ensure seamless care integration and reimbursement alignment.

Requirements

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

Qualifications

Preferred qualifications include:

• Experience with PDPM and reimbursement strategies.
• Strong collaboration and communication skills.
• Knowledge of federal and state long-term care regulations.

Skills

• Excellent organizational and time management skills.
• Ability to work independently and collaboratively.
• Strong analytical and problem-solving abilities.

Benefits

Comprehensive healthcare benefits, multiple medical plans, dental plans, vision plan, health savings account, flexible spending accounts, voluntary life and AD&D insurance, short-term and long-term disability plans, hospital indemnity insurance, critical illness insurance, accident insurance, whole life insurance, Medicare employee assistance legal plan, commuter benefits, 401k retirement plan, employee assistance program, paid time off, vacation, sick leave, and opportunities for career advancement.