Regional MDS Resource

Alvarado Care Center; Los Angeles (CA); On-site; USD 90,000 - 120,000; Full time

Job summary

Alvarado Care Center is seeking a Regional MDS Nurse Coordinator to oversee MDS operations across multiple SNFs. You will audit assessments, optimize PDPM reimbursement, and guide facility teams to ensure regulatory compliance. Requires CA RN/LVN license and 3+ years MDS experience.

Role involves travel across Los Angeles County and surrounding regions, mentoring MDS Coordinators, DONs, and clinical staff while supporting reimbursements and quality metrics.

Qualifications

• Active California RN or LVN license in good standing.
• Minimum 3 years of MDS experience in a Skilled Nursing Facility.
• Minimum 2 years of multi-facility, consulting, or regional clinical experience preferred.
• Extensive knowledge of MDS 3.0, RAI Manual, PDPM reimbursement methodology, care planning, QM and Five-Star Program; CMS and CA SNF regulations.
• Strong clinical assessment and auditing skills.
• Proficient with electronic health records and MDS software systems.

Responsibilities

• Provide oversight and support for MDS operations at multiple SNFs.
• Monitor MDS submission processes for CMS/state compliance.
• Conduct routine audits of MDS assessments, care plans, and clinical records.
• Analyze PDPM reimbursement outcomes and identify optimization opportunities.
• Monitor QMs and Five-Star performance; develop improvement plans.
• Educate and mentor MDS staff and interdisciplinary teams.

Skills

RN/LVN license

MDS experience (3y)

multi-facility/regional exp

MDS 3.0

RAI Manual

PDPM knowledge

Care planning

Quality Measures & Five-Star

CMS & CA SNF regs

clinical assessment & auditing

EHR/MDS software proficiency

travel ability (LA, SB, Contra Costa &

Tools

MDS software

Job description

POSITION TITLE

The RAI/MDS policy will provide the scope of the MDS Nurse Coordinator position for the facility.

Occupational Exposure: Category I

Department: Nursing

Reports to: VP of Clinical Services

FLSA: Non- exempt

POSITION SUMMARY

The Regional MDS Resource provides clinical and regulatory oversight of the Minimum Data Set (MDS) process across multiple Skilled Nursing Facilities (SNFs). This role ensures accurate and timely completion of MDS assessments, care planning, Medicare and Medicaid reimbursement optimization, quality measure performance, and regulatory compliance. The Regional MDS Resource serves as a resource and mentor to facility MDS Coordinators, Directors of Nursing, and interdisciplinary teams while supporting operational and financial outcomes throughout the organization.

POSITION RELATIONSHIP

Collaborates with all MDS Coordinators in the facilities, physicians and facility leadership and other department employees as the Regional MDS Resource coordinates resident assessment instrument implementation. Provides resident assessment related education.

QUALIFICATIONS

1. PROFESSIONAL

• Active California Registered Nurse (RN) or Licensed Vocational Nurse (LVN) license in good standing.
• Minimum of 3 years of MDS experience in a Skilled Nursing Facility.
• Minimum of 2 years of multi-facility, consulting, or regional clinical experience preferred.
• Extensive knowledge of:
  • MDS 3.0
  • RAI Manual
  • PDPM reimbursement methodology
  • Care planning processes
  • Quality Measures and Five-Star Program
  • CMS and California SNF regulations
• Strong clinical assessment and auditing skills.
• Excellent communication, organizational, and leadership abilities.
• Proficiency with electronic health records and MDS software systems.
• Ability to travel regularly throughout the Los Angeles County, Santa Barbara County, Contra Costa County and surrounding regions.

Preferred

• RAC-CT Certification.
• Previous experience as MDS Coordinator, Regional MDS Consultant, or Regional Clinical Consultant.
• Experience supporting multiple facilities within a post-acute care organization.

2. POSITION RESPONSIBILITIES

• a. Provide oversight and support for MDS operations at multiple SNFs.
• b. Monitor MDS submission processes and ensure compliance with CMS and state requirements.
• c. Conduct routine audits of MDS assessments, care plans, CAA documentation, and supporting clinical records.
• d. Analyze reimbursement outcomes under PDPM and identify opportunities for optimization while maintaining compliance.
• e. Monitor facility performance related to the Skilled Nursing Facility Quality Reporting Program (SNF QRP), including review of quality measure data, compliance requirements, reporting deadlines, and opportunities for performance improvement.
• f. Analyze QRP metrics and trends, collaborate with facility leadership to develop action plans, and provide education to improve quality outcomes and reduce the risk of payment penalties.
• g. Assist facilities with Additional Documentation Requests (ADRs), Targeted Probe & Educate (TPE) reviews, Medicare audits, and other payer documentation reviews.
• h. Coordinate the collection, review, and submission of medical records and supporting documentation in response to ADRs and audit requests.
• i. Provide guidance to facility teams regarding documentation standards, medical necessity requirements, and strategies to reduce claim denials while maintaining regulatory compliance.
• j. Track ADR outcomes, denial trends, and appeal opportunities, and recommend corrective actions to improve facility performance and reimbursement outcomes.
• k. Develop and implement educational programs related to MDS accuracy, QRP compliance, PDPM optimization, ADR preparedness, and regulatory requirements.
• l. Track and monitor Quality Measures (QMs), Five-Star ratings, and facility performance metrics.
• m. Educate and mentor MDS Coordinators, DONs, and interdisciplinary teams regarding MDS regulations, coding guidelines, and best practices.
• n. Collaborate with facility leadership to identify areas of clinical and operational improvement.
• o. Conduct onsite facility visits and remote reviews as needed.
• p. Maintain current knowledge of CMS regulations, RAI Manual updates, PDPM requirements, and California-specific regulations.
• q. Participate in corporate clinical meetings and provide regular performance reports to leadership.
• r. Implement and monitor the effectiveness of AI software tools, documentation review, assessment support, and reimbursement analytics tools, ensuring compliance with CMS, HIPAA, and organizational standards.
• s. Perform other related duties as required or assigned.