RAI MDS Specialist

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

Role: RAI MDS Specialist

Position Summary

The RAI MDS Specialist supports the RAI/MDS process by assisting with accurate, timely, and compliant completion of MDS assessments and related documentation. This position works closely with MDS Coordinators, nursing leadership, therapy, and interdisciplinary team members to promote accurate MDS coding, PDPM reimbursement, and regulatory compliance.

Key Responsibilities

• Assist MDS Coordinators with review and completion of MDS assessments in accordance with CMS/RAI requirements.
• Review clinical documentation to identify appropriate diagnoses, treatments, services, and supporting documentation for MDS coding.
• Assist with monitoring MDS completion timelines, ARDs, and submission requirements.
• Support PDPM accuracy through review of clinical documentation and identification of potential missed opportunities.
• Assist with audits, Quality Measure reviews, and identification of documentation trends or areas requiring improvement.
• Provide education and clarification to facility staff regarding MDS/RAI requirements as directed by the RAI Specialist.
• Assist with preparation of supporting documentation for Medicare reviews, ADRs, and appeals.
• Monitor compliance with MDS processes and communicate identified concerns to the RAI MDS Specialist and facility leadership.
• Maintain knowledge of current CMS, RAI, MDS, and PDPM regulations and guidance.

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.