MDS Coordinator - Director of Care Coordination - RN

Diversicare of Shelby•Shelby, MS

16d

About The Position

Diversicare is seeking an MDS Coordinator/Clinical Coordinator who is an RN to oversee accurate, timely, and compliant MDS assessments and coordinate patient and resident care. The role coordinates the RAI process, supports interdisciplinary care planning, manages care reviews and authorizations, and communicates with patients, families, payers, and insurance case managers. The position also supports regulatory compliance, quality measures, restorative nursing, discharge planning, and billing review processes. The posting notes that LPNs may be considered at centers where an RN is present in the department.

Requirements

Current RN license in the state of employment; LPNs may be considered in centers where an RN is present in the department.
Previous MDS/RAI experience.
Experience providing strategic leadership, managing teams, and leading projects to achieve desired outcomes.
Strong verbal, written, and interpersonal skills.
Strong communication, collaboration, and organizational skills.
Proficiency with computers and technology, including the ability to move easily between different software platforms.

Nice To Haves

Skilled nursing or long-term care experience, including knowledge of regulatory requirements.
Knowledge of PDPM, managed care reimbursement, utilization and case management, and discharge planning.

Responsibilities

Coordinate the RAI process and ensure MDS assessments are accurate, timely, and compliant with state and federal regulations.
Collaborate with the interdisciplinary team during the assessment observation period to ensure medical records contain documentation supporting the MDS.
Conduct observations and interviews with center team members, patients, residents, and family members to support accurate assessments.
Ensure interdisciplinary team members complete their designated MDS sections.
Maintain the MDS assessment tracking system, including schedules, timeframes, and due dates.
Audit MDS assessments according to company guidelines and routinely educate center team members about the RAI process.
Coordinate and complete electronic MDS submissions in accordance with federal regulations.
Obtain, review, and maintain state and federal reports and make corrections promptly.
Monitor Quality Measures and collaborate with the interdisciplinary team to ensure MDS assessments accurately support and reflect them.
Ensure Medicare and Medicaid regulatory requirements are completed accurately and on time, including certifications, beneficiary notices, skilled documentation, and coverage criteria.
Determine when non-coverage notification is needed and coordinate communications with patients, families, payers, and the interdisciplinary team.
Collaborate with the clinical team to develop and execute care plans and conferences.
Facilitate daily care coordination meetings to align care resources with benefits and patient needs.
Facilitate and participate in 72-hour meetings as part of the care management team.
Facilitate completion of aftercare calls.
Coordinate the restorative nursing program in collaboration with the interdisciplinary team.
Ensure timely communication with patients and families about changes in condition, discharge planning, and post-discharge matters, and document communications in the medical record.
Manage initial, concurrent, and discharge reviews, including managed care authorizations, reauthorizations, and discharge summaries.
Maintain ongoing communication with insurance case managers.
Obtain and record Managed Care Part B authorizations for the therapy department.
Ensure use of company care management tools and resources, including PCC, SHP, and Managed Care Master.
Facilitate patient care rounds and conferences promptly to review treatment plans and identify discharge and post-discharge needs.
Participate in the End of Month Billing Review Foundational Process.
Perform other job assignments as directed by the Administrator.