MDS / RAI Specialist — PDPM & Compliance Expert

Pacificare Health Management; Los Angeles (CA); On-site; USD 85,000 - 120,000; Full time

Job summary

Pacificare Health Management in Los Angeles is seeking an RAI MDS Specialist to support CMS/RAI processes, ensuring accurate MDS assessments, PDPM reimbursement, and regulatory compliance. This role collaborates with MDS Coordinators, nursing leadership, therapy, and the interdisciplinary team to review documentation and code appropriately.

Responsibilities include auditing MDS timelines, ARDs, and PDPM accuracy, preparing documentation for Medicare reviews, and educating facility staff on

Qualifications

• Current RN or LVN/LPN license preferred.
• Previous MDS/RAI, SNF, clinical documentation, or PDPM experience preferred.
• Strong knowledge of clinical documentation and attention to detail.
• Ability to analyze medical records and communicate effectively with interdisciplinary teams.
• RAC certification or willingness to obtain certification preferred.

Responsibilities

• Assist MDS Coordinators with review and completion of MDS assessments per CMS/RAI.
• Review clinical documentation to identify diagnoses, treatments, and supporting documentation for MDS coding.
• Monitor MDS completion timelines, ARDs, and submission requirements.
• Support PDPM accuracy by reviewing documentation and identifying missed opportunities.
• Assist with audits, Quality Measure reviews, and identification of documentation gaps.
• Educate facility staff on MDS/RAI requirements as directed by the RAI Specialist.
• Prepare supporting documentation for Medicare reviews, ADRs, and appeals.
• Monitor compliance with MDS processes and communicate concerns to leadership.
• Maintain knowledge of CMS, RAI, MDS, and PDPM regulations.

Skills

MDS/RAI knowledge

Attention to detail

Interdisciplinary communication

Regulatory compliance

Analytical skills

Education

RN license

LVN/LPN license

Job description

Pacificare Health Management in Los Angeles is seeking an RAI MDS Specialist to support CMS/RAI processes, ensuring accurate MDS assessments, PDPM reimbursement, and regulatory compliance. This role collaborates with MDS Coordinators, nursing leadership, therapy, and the interdisciplinary team to review documentation and code appropriately.

Responsibilities include auditing MDS timelines, ARDs, and PDPM accuracy, preparing documentation for Medicare reviews, and educating facility staff on