A Registered Nurse provides medical care and treatment, educates patients about their conditions, and provides emotional support to patients and families. Works in hospitals, schools, clinics or community health centers. Works under the supervision of a physician or other specialist, and serves as the primary point of care for patients in a hospital setting. May specialize in emergency room work, or treatment for a particular condition, or specialize in working with infants, the elderly or other patient groups. May work as an advanced practice specialists and prescribe medications in addition to offering specialty care.
Overview We are seeking a highly motivated and detail-oriented MDS Coordinator to join our team. In this pivotal role, you will oversee the comprehensive assessment and documentation process for residents in long-term care facilities, ensuring compliance with federal and state regulations. Your expertise will support optimal patient care, accurate Medicare and Medicaid billing, and adherence to clinical documentation standards. This position offers an exciting opportunity to contribute to quality improvement initiatives while working in a fast-paced, collaborative environment. Duties Lead the development and completion of the Minimum Data Set (MDS) assessments for residents, ensuring accuracy and timeliness in accordance with CMS (Centers for Medicare and Medicaid Services) guidelines. Collaborate with interdisciplinary teams—including nursing, therapy, social services, and medical staff—to gather comprehensive clinical information necessary for MDS coding and documentation. Review medical records, clinical documentation, and health information to ensure compliance with HIPAA (Health Insurance Portability and Accountability Act), state healthcare regulations, and clinical documentation standards. Utilize EMR/EHR systems Perform CPT coding, ICD-9/ICD-10 coding, DRG assignment, and utilization management to support appropriate reimbursement and quality metrics. Participate in discharge planning, case management activities, and coordination of hospice or acute care services as needed to support patient care transitions. Maintain detailed documentation logs, audit trails, and compliance reports Experience Utah RN or LPN license required (RN preferred) Proven experience in long-term care settings such as nursing homes or skilled nursing facilities with familiarity of CMS regulations and Medicare requirements. Strong background in clinical documentation improvement (CDI), utilization review, case management or medical management roles within inpatient or outpatient environments. Demonstrated knowledge of
ICD-10/ICD-9
coding systems, CPT coding procedures, DRG assignment, and health information management practices. Experience working with EMR/EHR systems Knowledge of health regulation policies including HIPAA privacy rules, state healthcare regulations related to long-term care facilities, Medicare/Medicaid policies and NCQA standards. Excellent understanding of medical terminology, anatomy/physiology concepts and medical records management to ensure precise documentation review. Strong communication skills paired with the ability to work independently while collaborating effectively within multidisciplinary teams are essential for success in this role. Join us as an MDS Coordinator if you're passionate about enhancing patient outcomes through meticulous documentation while navigating complex regulatory environments! We're committed to supporting your professional growth with ongoing training opportunities—empowering you to make a meaningful difference every day!
