MDS Specialist RN at CareOne Management LLC

Morristown, New Jersey, United States -

Full Time

Start Date

Immediate

Expiry Date

17 Aug, 26

Salary

120000.0

Posted On

19 May, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

MDS, Clinical Reimbursement, Regulatory Compliance, Care Planning, Utilization Review, Audit Readiness, Interdisciplinary Collaboration, Attention to Detail, Clinical Documentation, Nursing Practices, Software Proficiency, Analytical Skills, Patient Care, Reimbursement Strategy, Quality Measure Optimization, CMS Regulations

Industry

Hospitals and Health Care

Description

Balance Life & Work with a New Career Opportunity SKILLED NURSING Now Hiring - Lead MDS/Clinical Reimbursement Coordinator - Morristown, NJ CareOne at Madison Salary Range $83,000 to $120,000 Lead MDS/Clinical Reimbursement Coordinator will be responsible for, but not limited to: * MDS/RAI Process Leadership: Direct the timely and accurate completion of the Minimum Data Set (MDS) and Care Area Assessments (CAAs) in strict compliance with CMS regulations. * PDPM & Reimbursement Strategy: Strategically schedule ARDs and audit clinical documentation to capture true resident acuity, optimizing PDPM components, nursing tiers, and NTA scores. * Quality Measure & Five-Star Optimization: Analyze Casper reports and partner 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 the weekly Utilization Review (UR) and Triple-Check meetings, collaborating with therapy, nursing, and the business office to validate medical necessity, track managed care authorizations, and ensure accurate billing alignment prior to transmission. * Audit Readiness & Compliance: Systematically audit clinical records (MARs/TARs/physician orders) 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. Position Requirements: * Licensure: Current, unrestricted Registered Nurse (RN) license in the state of practice. * MDS Experience: 1–3 years of dedicated MDS experience preferred; or an 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. The CareOne mission is to define excellence within the health care community. We are dedicated to Maximizing Patient Outcomes. We treat Residents, their families and each other with respect, dignity and compassion. Through a collaborative and consultative approach, we strive to provide a framework of strength and stability for our Centers and Communities. We work to maintain the highest standards of care and service for Residents, families and our valued employees. We are proud to Offer the following benefits to Part-time (22.5+ hours/week) and Full-time Employees: * Comprehensive Healthcare Benefits * Multiple Medical Plans * Including Pharmacy * Including Teladoc * Multiple Dental Plans * Vision Plan * Health Savings Account (eligibility restrictions apply) * 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 * Legal Plan * Commuter Benefits * 401k Retirement Plan * Employee Assistance Program (available to all employees) * Paid Time Off * Vacation * Sick Plans in accordance with state laws * Opportunities to advance and grow your career If working with people who are dedicated, compassionate, and concerned about their patients is essential to you, then you'll appreciate being a part of our team. We've built a strong reputation on the outstanding level of care that we provide. We have a graciously appointed facility with strong belief in patient care and service; join us at our beautiful facility! We are an Equal Opportunity Employer EEO/AA/M/F/DV

Responsibilities

The Lead MDS/Clinical Reimbursement Coordinator will oversee the MDS/RAI process, ensuring compliance with CMS regulations and optimizing reimbursement strategies. They will also lead interdisciplinary care planning and utilization review meetings to ensure accurate billing and quality care.