| Location | Whippany, NJ |
| Salary | $83,000–$120,000 Per Year |
JobID: 20226809
Category: Center
JobSchedule:
Posted Date: 2026-06-19T13:27:16+00:00
JobShift: 1st
Location Type: Skilled
Balance Life & Work with a New Career Opportunity
Now Hiring- Lead MDS/Clinical Reimbursement Coordinator- Whippany, NJ
CareOne at Hanover
Salary Range $83,000 to $120,000 (Full-time)
Lead MDS/Clinical Reimbursement Coordinator will be responsible for, but not limited to:
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.
Position Requirements:
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.