Position Overview Bayshire Senior Communities is seeking an experienced Illinois RAI/MDS Consultant to support our skilled nursing facilities. This position provides oversight, education, auditing, and regulatory guidance to facility MDS coordinators and interdisciplinary teams.

The ideal candidate will have extensive knowledge of the CMS Resident Assessment Instrument (RAI) , Medicare PDPM, and the Illinois Department of Healthcare and Family Services (HFS) Medicaid reimbursement methodology . This role is responsible for promoting accurate assessments, compliant reimbursement, effective care planning, and improved quality outcomes. Additional Details Applicants must have at least 3 years' experience in Skilled Nursing Facilities Applicants must have strong ICD-10 knowledge LVN/LPN License preferred, not required 3 years' experience in Medical Records Local travel required around Marion, Pinckneyville, Greenville, and Eldorado areas of southern Illinois. Applicants must have reliable transportation. Mileage is reimbursed. Key Responsibilities Provide consultation, oversight, and education to facility MDS coordinators and interdisciplinary teams. Ensure timely and accurate completion of OBRA, Medicare PPS, IPA, discharge, tracking, and other required assessments. May be required to provide hands-on assistance with completing MDS assessments and to audit MDS assessments, clinical documentation, Care Area Assessments, and care plans for accuracy, consistency, and regulatory compliance. Apply expert knowledge of Illinois HFS requirements , including Illinois Medicaid PDPM nursing case-mix methodology, quarterly case-mix calculations, and applicable HFS rules. Review Medicare PDPM classifications, ICD-10 diagnoses, Section GG, skilled nursing documentation, therapy services, restorative programs, and other reimbursement-supporting documentation. Identify missed, late, incomplete, or inaccurate assessments and coordinate appropriate corrections or modifications. Monitor MDS submissions through iQIES and assist facilities with warnings, errors, and rejected records. Lead Medicare triple-check and reimbursement review processes in collaboration with nursing, therapy, medical records, billing, and business office teams. Monitor MDS-related quality measures, Quality Reporting Program results, and Five-Star performance to identify improvement opportunities. Develop corrective action plans and provide follow-up monitoring when documentation, coding, scheduling, or compliance concerns are identified. Prepare facilities for HFS reviews, CMS audits, Medicare reviews, state surveys, and other regulatory or reimbursement audits. Educate staff on CMS RAI updates, Illinois HFS requirements, PDPM, documentation standards, care planning, and quality measures. Required Qualifications Current, unrestricted Illinois Registered Nurse license . At least three years of recent RAI/MDS experience in a skilled nursing or long-term care setting. Strong knowledge of the current

CMS MDS 3.0 RAI

User's Manual, OBRA requirements, Medicare PPS assessments, PDPM, and comprehensive care planning. Extensive working knowledge of Illinois HFS, Illinois Medicaid nursing facility reimbursement, and the Illinois PDPM-based nursing case-mix methodology. Experience auditing MDS assessments and validating coding against supporting clinical documentation. Strong knowledge of ICD-10 coding, Section GG, skilled documentation, quality measures, and reimbursement compliance. Proficiency with iQIES and long-term care electronic health record systems. PointClickCare, MatrixCare, or comparable software experience is preferred. Strong analytical, organizational, teaching, and communication skills. Ability to work independently, manage multiple facilities and deadlines, and travel within Illinois as required. Preferred Qualifications RAC-CT, RAC-CTA, or comparable MDS certification. BSN or advanced nursing degree. Previous multi-facility, regional, corporate, or consultant-level MDS experience. Experience with HFS reviews, Medicare audits, survey preparation, denial prevention, and reimbursement recovery. Join Bayshire Senior Communities The Illinois RAI/MDS Consultant will play an important role in strengthening clinical documentation, supporting facility teams, ensuring regulatory compliance, and promoting accurate reimbursement and high-quality resident care. Bayshire Senior Communities is an equal opportunity employer and considers qualified applicants without regard to any legally protected status.

Pay:

$110,000.00 - $120,000.00 per year

Benefits:

401(k) 401(k) matching Dental insurance Flexible schedule Health insurance Health savings account Life insurance Paid time off Travel reimbursement Vision insurance

Work Location:

In person