MDS Specialist RN

Care One • Morristown, NJ

2d • $83,000 - $120,000 • Onsite

About The Position

CareOne at Madison is seeking a Lead MDS/Clinical Reimbursement Coordinator in Morristown, NJ. This role is responsible for leading the MDS/RAI process, optimizing reimbursement strategies through 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 goal is to maximize patient outcomes and maintain high standards of care.

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.

Benefits

• Comprehensive Healthcare Benefits (Multiple Medical Plans including Pharmacy and Teladoc, Multiple Dental Plans, Vision Plan)
• Health Savings Account (eligibility restrictions apply)
• Flexible Spending Accounts
• Voluntary Life and AD&D
• Short-Term and Long-Term Disability Plans
• Hospital Indemnity Insurance
• Critical Illness Insurance
• Accident Insurance
• Whole Life Insurance
• Medicare Employee Assistance
• Legal Plan
• Commuter Benefits
• 401k Retirement Plan
• Employee Assistance Program (available to all employees)
• Paid Time Off (Vacation, Sick Plans in accordance with state laws)
• Opportunities to advance and grow your career

What This Job Offers

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