MDS Specialist RN

CareOne LLC; New Jersey; On-site; USD 83,000 - 120,000; Full time

Benefits offered by this job

Multiple Medical Plans

401k Retirement Plan

Opportunities for career growth

Paid Time Off

Job summary

CareOne LLC is hiring a Lead MDS/Clinical Reimbursement Coordinator for their Whippany, NJ location. This full-time position involves directing MDS processes and ensuring compliance with CMS regulations to optimize reimbursement.

The ideal candidate will have a current RN license and relevant MDS experience. They will work closely with interdisciplinary teams to support patient care and audit readiness. Join us at CareOne, where we prioritize compassion and excellence in healthcare.

Qualifications

• 1–3 years of dedicated MDS experience preferred.
• Thorough knowledge of CMS RAI guidelines and federal/state long-term care regulations.
• Strong understanding of general, rehabilitative, and restorative nursing practices.

Responsibilities

• Direct the timely completion of the Minimum Data Set (MDS) and Care Area Assessments (CAAs).
• Lead Utilization Review meetings to ensure accurate billing alignment.
• Monitor clinical triggers and safeguard the facility's Five-Star rating.

Skills

MDS experience

Regulatory expertise

Clinical knowledge

Operational skills

Software proficiency

Education

Current Registered Nurse (RN) license

Tools

PointClickCare

Microsoft Windows applications

Job description

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 NetHealthis 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:

Multiple Medical Plans

Including Pharmacy

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

Whole Life Insurance

Legal Plan

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

Job Info

• Job Identification 20226809
• Job Category Center
• Posting Date 06/19/2026, 01:27 PM
• Apply Before 09/01/2026, 01:26 PM
• Job Shift 1st
• Locations 101 Whippany Rd, Whippany, NJ, 07981, US
• Position Type Full-Time (37.5+) – CareOne MA, NJ, River Glen
• New Position Salary Range Salary Range $83,000 to $120,000