MDS Specialist RN

CareOne Group • Hackensack, NJ

4d • $83,000 - $120,000 • Onsite

About The Position

CareOne at Wellington is hiring a Lead MDS/Clinical Reimbursement Coordinator in Hackensack, New Jersey. The role leads MDS and clinical reimbursement processes, supporting accurate regulatory assessments, resident care planning, reimbursement alignment, audit readiness, and quality outcomes. The stated salary range is $83,000 to $120,000.

The coordinator works with nursing, therapy, the business office, the Director of Nursing, and the interdisciplinary team (IDT) to oversee assessment and care planning, utilization review, billing validation, and clinical documentation. The role requires accuracy, autonomy, and flexibility to meet regulatory deadlines and support month-end financial close procedures.

Requirements

• Current, unrestricted RN or LPN license in the state of practice.
• Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal and state long-term care regulations.
• Strong understanding of general, rehabilitative, and restorative nursing practices, including comprehensive care planning.
• Proficiency with Microsoft Windows applications.
• Exceptional attention to detail and demonstrated ability to complete assessments accurately and within regulatory deadlines.
• Ability to work independently and adjust scheduling to support month-end financial close procedures.

Nice To Haves

• One to three years of dedicated MDS experience is preferred; an experienced long-term-care RN with strong clinical and analytical skills may be trained.
• Experience with PointClickCare (PCC) and NetHealth is highly preferred.

Responsibilities

• Direct timely and accurate completion of Minimum Data Set (MDS) assessments and Care Area Assessments in compliance with CMS regulations.
• Strategically schedule assessment reference dates (ARDs) and audit clinical documentation to capture resident acuity and optimize PDPM components, nursing tiers, and NTA scores.
• Analyze Casper reports and partner with the DON and IDT to monitor clinical triggers, drive root-cause corrections, and safeguard the facility's Five-Star rating.
• Oversee individualized resident care plans that support MDS coding, establish clear goals, and meet regulatory requirements.
• Lead weekly Utilization Review and Triple-Check meetings with therapy, nursing, and the business office to validate medical necessity, track managed care authorizations, and align billing before transmission.
• Audit clinical records, including MARs, TARs, and physician orders, to defend data integrity in ADRs, MAC/RAC audits, and pre-payment reviews.
• Facilitate interdisciplinary meetings to support integrated care and reimbursement alignment.
• Adjust scheduling as needed to support month-end financial close procedures.

Benefits

• Comprehensive healthcare benefits, including multiple medical plans and pharmacy coverage, Teladoc, dental and vision plans, health savings account subject to eligibility restrictions, and flexible spending accounts.
• Voluntary life and AD&D insurance, short- and long-term disability plans, hospital indemnity insurance, critical illness insurance, accident insurance, and whole life insurance.
• Medicare Employee Assistance and an Employee Assistance Program available to all employees.
• Legal plan.
• Commuter benefits.
• 401(k) retirement plan.
• Paid time off, including vacation and sick plans in accordance with state laws.
• Opportunities to advance and grow your career.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed