MDS Specialist RN

Balance Life & Work with a New Career Opportunity Now Hiring - Lead MDS/Clinical Reimbursement Coordinator - Whippany, NJ CareOne at Hanover Salary Range $83,000 to $120,000 (Full-time) 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.