Regional QS Lead - FL /MDS Consultant

ADP; San Diego (CA); Presencial; USD 120.000 - 180.000; Jornada completa

Descripción de la vacante

ADP is seeking a Regional Quality Service Director / MDS Consultant to lead clinical quality oversight across multiple facilities. The role focuses on regulatory compliance, survey readiness, and reimbursement optimization with PDPM and Medicaid case-mix considerations.

You will work with administrators, nursing leadership, and MDS teams to ensure high-quality care, accurate documentation, and efficient operations, including staff training and interdepartmental collaboration.

Formación

• Bachelor’s or Associate’s degree in Nursing.
• Current LPN license in Florida; RN license preferred.
• Minimum 3 years in long-term care or healthcare coordination.
• Strong knowledge of the MDS process, regulations, documentation requirements.
• Excellent communication, interpersonal, data analysis, and organizational skills.
• Ability to travel up to 100%.

Responsabilidades

• Ensure facilities comply with AHCA, CMS, and other state/federal regulations.
• Support survey readiness and development of Plans of Correction (POCs).
• Oversee MDS submissions and PDPM/Medicaid case-mix reimbursement accuracy.
• Provide clinical training and guidance to facility staff.
• Collaborate with interdisciplinary teams to improve quality metrics and outcomes.
• Monitor incident reports, care conferences, and care plan updates.

Conocimientos

Clinical leadership

Regulatory guidance

MDS coordination

Quality improvement

Infection prevention

Data analysis

Educación

Bachelor’s or Associate’s degree in Nursing

Descripción del empleo

Job Title: Regional Quality Service Director - FL / Clinical Reimbursement/ MDS Consultant

Department: Quality Services

FLSA Classification: Exempt

Reports To: Chief Clinical Officer

Status: Full Time

Revised Date: 09/23/2026

The Regional Quality Service Director / MDS Consultant supports assigned facilities by providing clinical quality oversight, survey readiness support, regulatory guidance, and MDS consultation. This dual role works collaboratively with Quality Service Consultants, Administrators, Directors of Nursing Services, MDS teams, and interdisciplinary care teams to promote clinical competency, regulatory compliance, adverse event prevention, infection prevention, accurate reimbursement practices, and quality outcomes across multiple facilities.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Regional Quality Service Director Responsibilities

• Ensures assigned facilities comply with organizational policies and procedures, as well as applicable Florida Agency for Health Care Administration (AHCA), Centers for Medicare & Medicaid Services (CMS), and other state and federal regulations.
• Supports survey readiness and preparedness for state (AHCA) and federal (CMS) surveys, assists during actual surveys as needed, and supports facilities with development of Plans of Correction (POCs).
• Reviews facility clinical systems and recommends appropriate clinical protocols, programs, and process improvements as applicable.
• Assists in the development and recommendation of nursing policies and procedures that align with current standards of nursing practice, facility philosophy, operational policies, and applicable state and federal regulations.
• Participates in management team meetings to discuss resident status, census changes, personnel matters, and resident complaints or concerns.
• Performs clinical audits as frequently as needed, including resident chart reviews, medication room audits, and quality assurance follow-up, based on facility needs, survey readiness, regulatory risk, and identified areas of concern.
• Regularly monitors wound care provided in assigned facilities to ensure appropriateness and effectiveness.
• Partners with executive leadership, including the Administrator and Director of Nursing, to align clinical operations with facility financial goals and promote procurement efficiency, including pharmacy expenses, medical supplies, and other cost-sensitive clinical resources.
• Attends meetings as required and works cooperatively with members of the management and care team, maintaining effective interdepartmental and interpersonal relationships with residents, staff, and visitors.
• Reviews incident reports and follow-up notes regularly to ensure reportable incidents are submitted timely, proper procedures are followed, and documentation is complete.
• Addresses complaints and resolves problems as needed.
• Participates in care conferences as needed or requested by the facility.
• Performs comprehensive assessments on potential residents.
• Provides clinical training and support to facility staff.
• Performs regular reviews of Electronic Medication Administration Record reports to ensure medication room compliance.
• Conducts medication pass observations and supervisory visits to medication passers as frequently as needed, including during survey preparation or based on facility needs, regulatory risk, and identified areas of concern, in states that allow RN delegation.
• Assists with hiring, training, planning, assigning, and directing the work of facility staff as needed.
• Oversees the completion, accuracy, and timely submission of MDS assessments across multiple facilities.
• Ensures compliance with federal and state regulations related to MDS documentation, reimbursement, and quality reporting.
• Oversees clinical reimbursement accuracy under the Patient-Driven Payment Model (PDPM) and Florida’s Medicaid Case-Mix system.
• Actively participates in monthly Triple Check meetings as a standard skilled nursing facility reimbursement best practice to support billing accuracy, clinical documentation compliance, and MDS coding accuracy.
• Tracks and analyzes Quality Measures (QMs) that directly affect a facility’s data for all QM programs, such as Five-Star Rating, Quality Reporting Program (QRP), and Value-Based Purchasing (VBP).
• Provides training, guidance, and ongoing support to facility staff on MDS processes, documentation standards, and best practices.
• Monitors, analyzes, and reports MDS data to support quality assurance, care planning, reimbursement accuracy, and regulatory compliance initiatives.
• Collaborates with interdisciplinary teams to develop, review, and update resident care plans based on MDS findings and facility needs.
• Facilitates regular meetings with facility teams to review MDS updates, address documentation concerns, and promote consistent best practices.
• Responds to inquiries and resolves issues related to MDS documentation, assessment completion, reimbursement, and related compliance matters. Performs other duties as assigned.

QUALIFICATIONS

Education: Bachelor’s or Associate’s degree in Nursing required.

Licensure: Current LPN license in the state of Florida required. RN license preferred.

Work Experience: Minimum of 3 years of experience in long-term care, skilled nursing, MDS coordination, or healthcare coordination required.

Knowledge: Strong knowledge of the MDS process, related regulations, documentation requirements, and skilled nursing facility standards.

Skills: Excellent communication, interpersonal, data analysis, reporting, problem-solving, and organizational skills.

Additional Requirements: Ability to work independently, manage multiple projects simultaneously, and collaborate effectively with facility leadership and interdisciplinary teams.

Preferred Certification: Certification in MDS, such as RAC-CT, preferred.

Travel: Ability to travel up to 100% of the time.