MDS & Care Plan Nurse: Care Coordination Lead

University Park Rehabilitation and Healthcare Center; Fort Wayne (IN); On-site; USD 65,000 - 90,000; Full time

Job summary

University Park Rehabilitation and Healthcare Center is seeking an RN MDS Coordinator to oversee Medicare/Medicaid MDS documentation, ensure accurate assessments, and coordinate interdisciplinary care for optimal reimbursement.

The ideal candidate holds current RN licensure, prefers long-term care experience, and can communicate clearly in English. This on-site role requires attention to regulatory timelines and collaboration across disciplines.

Qualifications

• Registered Nurse with current unencumbered state licensure.
• Long Term Care Experience preferred.
• Ability to read, write, speak and understand the English language.

Responsibilities

• Assesses and determines the health status and level of care of all new admissions.
• Ensures the accurate and timely completion of all MDS assessments (PPS Medicare, quarterly, annual, significant change).
• Communicates level of care for new residents to all disciplines.
• Coordinates interdisciplinary participation in completing the MDS for each admission within regulatory time frames.
• Maintains an accurate schedule of all MDS assessments with proper reference dates.
• Responsible for data entry and electronic submission of MDS assessments.
• Verifies electronic submissions and maintains appropriate records.
• Coordinates interdisciplinary participation in completing the MDS for each resident according to regulatory time frames.
• Schedules and conducts resident care conferences per state and federal regulations and ensures completion of all MDS reviews prior to resident care conference.
• Assists disciplines in formulating and revising care plans; ensures problem identification, prioritized goals, and appropriate nursing interventions.
• Evaluates resident care plans for comprehensiveness and individuality.
• Assesses achievement or lack of achievement of outcomes; updates care plans accordingly.
• Responsible for all levels of care changes within the facility and notifies departments when changes occur.
• Generates appropriate forms for level of acuity and changes; transmits forms to agencies as required by state law.
• Other duties as assigned.

Skills

RN licensure

Long term care

English fluency

Job description

University Park Rehabilitation and Healthcare Center is seeking an RN MDS Coordinator to oversee Medicare/Medicaid MDS documentation, ensure accurate assessments, and coordinate interdisciplinary care for optimal reimbursement.

The ideal candidate holds current RN licensure, prefers long-term care experience, and can communicate clearly in English. This on-site role requires attention to regulatory timelines and collaboration across disciplines.