Job Overview
We are seeking a dedicated and detail-oriented RN MDS Coordinator/Case Manager to join our healthcare team. The ideal candidate will possess a comprehensive understanding of clinical documentation standards, long-term care regulations, and healthcare reimbursement processes. In this role, you will be responsible for coordinating the Minimum Data Set (MDS) assessments, ensuring accurate documentation, and facilitating compliance with Medicare and Medicaid requirements. Your expertise in managed care, utilization management, and medical coding will be essential to optimize patient care and support regulatory adherence. This position offers an opportunity to impact patient outcomes positively while maintaining rigorous documentation practices within a dynamic healthcare environment. On call rotation once a month.
Responsibilities
- Conduct comprehensive MDS assessments in accordance with clinical documentation standards, ensuring accuracy and completeness.
- Review medical records and documentation to verify compliance with federal and state healthcare regulations, including CMS guidelines.
- Collaborate with interdisciplinary teams such as nursing, therapy, social work, and physicians to gather pertinent patient information for assessments.
- Ensure timely completion of MDS schedules and coordinate discharge planning activities to facilitate smooth transitions of care.
- Utilize EMR/EHR systems like PCC, Point Click Care, to document findings, update patient records, and manage electronic health records efficiently.
- Apply clinical knowledge of physiology, anatomy, and medical terminology to interpret complex medical data accurately.
- Maintain up-to-date knowledge of long-term care regulations, Medicare policies, ICD coding (ICD-9/ICD-10), CPT coding, DRG assignments, and health regulation policies.
- Support utilization management initiatives by reviewing medical necessity and optimizing resource utilization for inpatient and outpatient services.
- Participate in clinical documentation improvement programs to enhance accuracy and compliance with accreditation standards such as NCQA or CMS.
- Assist in training staff on documentation standards related to MDS completion, ICD coding practices, HIPAA compliance, and other regulatory requirements.
Experience
- Proven experience in long-term care settings such as nursing homes or skilled nursing facilities with familiarity in MDS coordination.
- Demonstrated expertise in managed care environments with knowledge of Medicare regulations and reimbursement processes.
- Strong background in medical operations or with inpatient or outpatient experience preferred.
- Proficiency in electronic health record (EHR) systems Clinical Works is required.
- Knowledge of health information management standards including clinical documentation improvement initiatives.
- Experience with discharge planning, hospice care coordination.
- Familiarity with coding systems such as ICD (ICD-9/ICD-10), CPT codes, DRGs, and long-term care regulations is essential for accurate documentation review.
- Ability to interpret medical terminology accurately while maintaining compliance with HIPAA and state healthcare regulations.
Join our team to ensure precise clinical documentation that enhances patient care quality while supporting regulatory compliance across diverse healthcare settings!
Pay: $45.00 - $48.00 per hour
Benefits:
- Dental insurance
- Disability insurance
- Flexible schedule
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Work Location: In person
