MDS Specialist RN

CareOne Group•Hanover Township, NJ

2d•$83,000 - $120,000•Onsite

About The Position

CareOne at Hanover is seeking a Lead MDS/Clinical Reimbursement Coordinator for their Whippany, NJ location. This full-time position offers a salary range of $83,000 to $120,000. The role involves leading the MDS/RAI process, optimizing reimbursement strategies (PDPM), improving quality measures and Five-Star ratings, overseeing interdisciplinary care planning, coordinating utilization review and triple-check meetings, ensuring audit readiness, and facilitating interdisciplinary collaboration. The ideal candidate will have a strong understanding of CMS regulations, clinical knowledge, and excellent operational and analytical skills.

Requirements

Current, unrestricted Registered Nurse (RN) license in the state of practice.
1–3 years of dedicated MDS experience preferred; or an experienced LTC RN with strong clinical and analytical skills who can be trained.
Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term care regulations.
Strong understanding of general, rehabilitative, and restorative nursing practices, including comprehensive care planning.
Skilled in Microsoft Windows applications.
Exceptional attention to detail with a proven ability to complete assessments accurately and within strict regulatory deadlines.
Ability to work independently and adjust scheduling to support crucial month-end financial close procedures.

Nice To Haves

Experience with PointClickCare (PCC) and NetHealth is highly preferred.

Responsibilities

Direct the timely and accurate completion of the Minimum Data Set (MDS) and Care Area Assessments (CAAs) in strict compliance with CMS regulations.
Strategically schedule ARDs and audit clinical documentation to capture true resident acuity, optimizing PDPM components, nursing tiers, and NTA scores.
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.
Oversee the development of individualized resident Care Plans that support MDS coding, establish clear goals, and satisfy all regulatory requirements.
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.
Systematically audit clinical records (MARs/TARs/physician orders) to defend data integrity against ADRs, MAC/RAC audits, and pre-payment reviews.
Facilitate interdisciplinary meetings to ensure seamless care integration and reimbursement alignment.