MDS Specialist RN
About The Position
CareOne at Hanover is hiring a Lead MDS/Clinical Reimbursement Coordinator in Whippany, New Jersey. The role leads the MDS/RAI process and clinical reimbursement activities, ensuring accurate assessments, regulatory compliance, resident-centered care planning, and alignment of clinical documentation with reimbursement and billing. The position requires collaboration with nursing, therapy, the business office, the Director of Nursing, and the interdisciplinary team. The listed salary range is $83,000 to $120,000 for full-time employment. The organization describes its mission as defining excellence in health care and maximizing patient outcomes, treating residents, families, and employees with respect, dignity, and compassion, and maintaining high standards of care and service.
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 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; experienced LTC RNs 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 (CAAs) in compliance with CMS regulations.
- Schedule Assessment Reference Dates (ARDs) strategically and audit clinical documentation to capture resident acuity and optimize PDPM components, nursing tiers, and NTA scores.
- Analyze Casper reports and work with the DON and interdisciplinary team to monitor clinical triggers, address root causes, and protect the facility’s Five-Star rating.
- Oversee individualized resident care plans that support MDS coding, establish 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 and audit readiness for ADRs, MAC/RAC audits, and pre-payment reviews.
- Facilitate interdisciplinary meetings to coordinate care and align reimbursement.
Benefits
- Comprehensive healthcare benefits, including multiple medical plans and pharmacy coverage, Teladoc, multiple dental plans, and a vision plan.
- Health Savings Account, subject to eligibility restrictions, and Flexible Spending Accounts.
- Voluntary life and AD&D, short-term and long-term disability, hospital indemnity, critical illness, accident, and whole life insurance.
- Medicare Employee Assistance.
- Legal plan.
- Commuter benefits.
- 401(k) retirement plan.
- Employee Assistance Program available to all employees.
- Paid time off, including vacation and sick plans in accordance with state laws.
- Opportunities to advance and grow your career.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
