MDS Specialist RN

CareOne • Morristown, NJ

2d • Onsite

About The Position

This position is for a Lead MDS/Clinical Reimbursement Coordinator at CareOne at Madison in Morristown, NJ. The role focuses on leading the Minimum Data Set (MDS) and Care Area Assessments (CAAs) process, ensuring compliance with CMS regulations. The coordinator will be responsible for optimizing PDPM components, quality measures, and Five-Star ratings through strategic scheduling and documentation audits. They will also oversee the development of individualized resident care plans, lead utilization review and triple-check meetings, and ensure audit readiness. Collaboration with interdisciplinary teams is crucial for seamless care integration and reimbursement alignment.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level