MDS Specialist RN

CareOne; Hackensack (NJ); Vor Ort; USD 83.000 - 120.000; Vollzeit

Benefits dieser Stelle

Comprehensive Healthcare Benefits

401k Retirement Plan

Paid Time Off

Professional development opportunities

Zusammenfassung

CareOne at Wellington is seeking a Lead MDS/Clinical Reimbursement Coordinator in Hackensack, NJ. You will direct MDS/RAI processes, strategize PDPM reimbursement, and drive quality measures to maintain a high Five-Star rating.

Responsibilities include interdisciplinary care planning, UR coordination, audits, and ensuring compliance with CMS regulations. Strong regulatory knowledge and PCC/NetHealth experience are preferred.

Qualifikationen

• MDS/RAI Process Leadership: Direct the timely and accurate completion of the MDS/CAAs in compliance with CMS regulations.
• PDPM & Reimbursement Strategy: Schedule ARDs and audit clinical documentation to optimize PDPM components and nursing tiers.
• Quality Measure & Five-Star Optimization: Analyze Casper reports with DON/IDT to monitor triggers and safeguard Five-Star rating.
• Interdisciplinary Care Planning: Oversee development of individualized resident care plans supporting MDS coding and regulatory requirements.
• Utilization Review & Triple-Check Coordination: Lead UR and Triple-Check meetings to validate medical necessity and billing alignment.
• Audit Readiness & Compliance: Audit MARs/TARs/physician orders to defend data integrity against ADRs and RAC audits.
• IDT Collaboration & Care Meetings: Facilitate interdisciplinary meetings for seamless care and reimbursement alignment.

Aufgaben

• Direct the MDS/RAI process with a focus on accuracy and compliance.
• Develop and implement PDPM strategies to maximize reimbursement.
• Monitor quality measures and partner with leadership to maintain Five-Star ratings.
• Coordinate interdisciplinary care planning to meet regulatory requirements.
• Lead weekly UR and Triple-Check processes for clinical justification and billing alignment.
• Ensure audit readiness by reviewing clinical records and orders.
• Foster collaboration across IDT for integrated patient care and reimbursement.

Kenntnisse

Attention to detail

Independent worker

Regulatory knowledge

Analytical skills

Communication skills

Ausbildung

RN or LPN license in state of practice

Tools

PointClickCare (PCC)

NetHealth

MS Windows

Jobbeschreibung

Balance Life & Work with a New Career Opportunity

Job Description

Balance Life & Work with a New Career Opportunity

SKILLED NURSING

Now Hiring - Lead MDS/Clinical Reimbursement Coordinator - Hackensack, NJ

CareOne at Wellington

Salary Range: $83,000 to $120,000

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 RN or LPN 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.

About Us

The CareOne mission is to define excellence within the health care community. We are dedicated to Maximizing Patient Outcomes. We treat Residents, their families and each other with respect, dignity and compassion. Through a collaborative and consultative approach, we strive to provide a framework of strength and stability for our Centers and Communities. We work to maintain the highest standards of care and service for Residents, families and our valued employees.

We are proud to Offer the following benefits to Part-time (22.5+ hours/week) and Full-time Employees:

• Comprehensive Healthcare Benefits
• Multiple Medical Plans
• Including Pharmacy
• Including Teladoc
• Multiple Dental Plans
• Vision Plan
• Health Savings Account (eligibility restrictions apply)
• Flexible Spending Accounts
• Voluntary Life and AD&D
• Short-Term and Long-Term Disability Plans
• Hospital Indemnity Insurance
• Critical Illness Insurance
• Accident Insurance
• Whole Life Insurance
• Medicare Employee Assistance
• Legal Plan
• Commuter Benefits
• 401k Retirement Plan
• Employee Assistance Program (available to all employees)
• Paid Time Off
• Vacation
• Sick Plans in accordance with state laws
• Opportunities to advance and grow your career

If working with people who are dedicated, compassionate, and concerned about their patients is essential to you, then you'll appreciate being a part of our team. We've built a strong reputation on the outstanding level of care that we provide. We have a graciously appointed facility with strong belief in patient care and service; join us at our beautiful facility!

We are an Equal Opportunity Employer

EEO/AA/M/F/DV