Find & Apply For Clinical Auditor / Utilization Reviewer Jobs in West Orange, New Jersey

Position Summary Daughters of Israel is seeking an experienced and detail-oriented

MDS/RAC-CT

Nurse to oversee the facility's MDS/RAI process and ensure accurate, timely, and compliant resident assessments and submissions. The ideal candidate will have strong hands-on experience with all aspects of the MDS 3.0 process in a skilled nursing or long-term care setting, including assessment scheduling, clinical documentation review, coding, interdisciplinary coordination, submission, corrections, and audits. The

MDS/RAC-CT

Nurse will serve as a clinical and regulatory resource to the interdisciplinary team and will be expected to remain current with CMS requirements, the RAI User's Manual, MDS changes, PDPM, quality measures, reimbursement requirements, and upcoming regulatory changes affecting MDS submissions. Key Responsibilities Manage and coordinate the facility's complete MDS/RAI process from assessment scheduling through final submission. Complete accurate and timely MDS assessments in accordance with current CMS, RAI, and New Jersey Department of Health requirements. Ensure all required assessments are completed within established regulatory timeframes. Review medical records, clinical documentation, physician orders, nursing documentation, therapy records, and other supporting information to ensure accurate MDS coding. Coordinate with nursing, rehabilitation, social services, dietary, activities, medical records, and other interdisciplinary team members to obtain accurate assessment information. Identify documentation gaps, inconsistencies, and potential coding errors and work with appropriate departments to resolve them. Ensure MDS assessments accurately reflect the resident's clinical condition, services received, functional status, diagnoses, and care needs. Maintain and monitor the MDS assessment schedule and submission deadlines. Complete appropriate corrections and follow-up related to submitted assessments. Monitor MDS-related documentation and processes to support accurate reimbursement and quality reporting. Apply current knowledge of

MDS 3.0, RAI

requirements, PDPM, CMS regulations, and applicable state requirements. Participate in and assist with MDS audits, quality assurance activities, QAPI initiatives, and regulatory survey preparation. Provide education and guidance to nursing and interdisciplinary staff regarding MDS documentation and coding requirements. Identify trends or recurring documentation issues and make recommendations for process improvement. Stay informed regarding current and upcoming CMS, MDS, RAI, PDPM, reimbursement, and regulatory changes and communicate relevant changes to facility leadership and staff. Serve as a resource to the interdisciplinary team regarding MDS requirements, documentation standards, and regulatory compliance. Maintain confidentiality and comply with HIPAA and all applicable federal and state regulations. Required Qualifications Current New Jersey RN license in good standing. RAC-CT certification strongly preferred. Significant experience as an MDS Coordinator, MDS Nurse, or MDS/RN in a skilled nursing or long-term care facility. Demonstrated experience managing all aspects of the MDS 3.0 assessment and submission process. Strong knowledge of the CMS RAI User's Manual and current MDS requirements. Thorough understanding of MDS scheduling, coding, documentation, submission, and correction processes. Knowledge of PDPM and the relationship between accurate MDS coding, reimbursement, quality measures, and resident care. Strong clinical assessment and critical-thinking skills. Excellent organizational skills and ability to independently manage multiple assessment deadlines. Strong attention to detail and commitment to accuracy. Excellent communication and interdisciplinary collaboration skills. Proficiency with electronic medical records and Microsoft Office. Preferred Qualifications RAC-CT certification. Experience serving as the primary MDS Coordinator for a skilled nursing facility. Experience conducting or participating in MDS audits. Experience with state and federal survey preparation and regulatory compliance. Experience providing MDS education to nursing and interdisciplinary staff. Experience with QAPI initiatives involving MDS, clinical documentation, reimbursement, or quality measures. Demonstrated ability to interpret and implement new and changing CMS and MDS requirements.

Pay:

From $85,000.00 per year

Benefits:

403(b) Dental insurance Disability insurance Flexible spending account Health insurance Health savings account Life insurance Paid time off Tuition reimbursement Vision insurance

Experience:

MDS:

3 years (Required)

License/Certification:

NJ RN License (Required) RAC-CT (Preferred)

Work Location:

In person