Now Hiring - Lead MDS/Clinical Reimbursement Coordinator - Whippany, NJ

CareOne at Hanover

Salary Range $83,000 to $120,000 (Full-time)

• MDS/RAI Process Leadership: Direct the timely and accurate completion of the Minimum Data Set (MDS) and Care Area Assessments (CAAs) in strict compliance with CMS regulations.
• PDPM & Reimbursement Strategy: Strategically schedule ARDs and audit clinical documentation to capture true resident acuity, optimizing PDPM components, nursing tiers, and NTA scores.
• Quality Measure & Five-Star Optimization: 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.
• Interdisciplinary Care Planning: Oversee the development of individualized resident Care Plans that support MDS coding, establish clear goals, and satisfy all regulatory requirements.
• Utilization Review & Triple-Check Coordination: 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.
• Audit Readiness & Compliance: Systematically audit clinical records (MARs/TARs/physician orders) to defend data integrity against ADRs, MAC/RAC audits, and pre-payment reviews.
• IDT Collaboration & Care Meetings: Facilitate interdisciplinary meetings to ensure seamless care integration and reimbursement alignment.

• Licensure: Current, unrestricted Registered Nurse (RN) license in the state of practice.
• MDS Experience: 1–3 years of dedicated MDS experience preferred; or an experienced LTC RN with strong clinical and analytical skills who can be trained.
• Regulatory Expertise: Thorough knowledge of CMS RAI guidelines, Medicare PPS/OBRA scheduling, and federal/state long-term care regulations.
• Clinical Knowledge: Strong understanding of general, rehabilitative, and restorative nursing practices, including comprehensive care planning.
• Software Proficiency: Skilled in Microsoft Windows applications; experience with PointClickCare (PCC) and NetHealth is highly preferred.
• Operational Skills: Exceptional attention to detail with a proven ability to complete assessments accurately and within strict regulatory deadlines.
• Autonomy & Flexibility: Ability to work independently and adjust scheduling to support crucial month-end financial close procedures.