MDS Specialist RN

CareOne • Hackensack, NJ

3d • Onsite

About The Position

CareOne at Wellington is hiring a Lead MDS/Clinical Reimbursement Coordinator in Hackensack, New Jersey. The role leads the Minimum Data Set (MDS) and Resident Assessment Instrument (RAI) process, supports clinical reimbursement strategy, and works with interdisciplinary teams to ensure compliant assessments, care planning, utilization review, and accurate billing. The listed salary range is $83,000 to $120,000.

The coordinator oversees timely and accurate MDS and Care Area Assessment completion in accordance with CMS regulations; uses assessment scheduling and clinical documentation review to support accurate resident acuity and reimbursement; monitors quality measures and Five-Star performance; and leads care planning, utilization review, triple-check coordination, audit readiness, and interdisciplinary care meetings. The role requires a current RN or LPN license in the state of practice. Dedicated MDS experience is preferred, though an experienced long-term-care RN with strong clinical and analytical skills may be trained.

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 ability to complete assessments accurately within strict 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.
• Experienced long-term-care RN with strong clinical and analytical skills may be trained for the role.
• Experience with PointClickCare (PCC) and NetHealth is highly preferred.

Responsibilities

• Direct timely and accurate completion of 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 Director of Nursing and interdisciplinary team to monitor clinical triggers, address root causes, 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 support data integrity in response to ADRs, MAC/RAC audits, and pre-payment reviews.
• Facilitate interdisciplinary meetings to support coordinated care and reimbursement alignment.
• Adjust scheduling as needed to support month-end financial close procedures.

What This Job Offers

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