MDS Specialist RN

CareOne; United States; On-site; USD 83,000 - 120,000; Full time

Job summary

CareOne in Whippany, NJ is seeking a Lead MDS/Clinical Reimbursement Coordinator to direct MDS/RAI processes and optimize PDPM. You will lead ARD scheduling, audit clinical documentation, and partner with the DON/IDT to safeguard the Five-Star rating.

You will oversee care planning, utilization review, and compliance across MARs/TARs. This role requires independent work, strong regulatory knowledge, and collaboration with multiple teams to ensure accurate billing prior to transmission.

Qualifications

• MDS experience of 1–3 years or experienced LTC RN trainable.
• Current RN or LPN license in state of practice.
• Thorough knowledge CMS RAI guidelines and scheduling.
• Strong clinical knowledge across general, rehabilitative, restorative care.
• Proficient with Windows systems; PCC and NetHealth preferred.
• Attention to detail with regulatory deadlines and data integrity.
• Able to work independently and support month-end close.

Responsibilities

• Direct the timely and accurate completion of MDS/CAAs per CMS rules.
• Strategically schedule ARDs and audit clinical documentation for PDPM.
• Analyze reports to optimize Five-Star rating and care triggers.
• Oversee individualized resident Care Plans and regulatory compliance.
• Lead UR and Triple-Check meetings with therapy, nursing, and business office.
• Systematically audit MARs/TARs/physician orders for data integrity.
• Facilitate interdisciplinary meetings to align care and reimbursement.

Skills

MDS/RAI Leadership

PDPM Strategy

Five-Star Optimization

Care Planning Oversight

UR/Triple-Check Coordination

Audit Readiness

IDT Collaboration

Education

RN/LPN License

MDS Experience 1–3 yrs

CMS RAI Regulations

Tools

PointClickCare

NetHealth

Microsoft Windows

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 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.