Specialist Rac Audit Jobs (NOW HIRING)

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SKILLED NURSING

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

CareOne at Madison

Salary Range $83,000 to $120,000

• 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.
   

The CareOne mission is to define excellence within the health care community. We are dedicated to Maximizing Patient Outcomes. We treat Residents, their families and each other with respect, dignity and compassion. Through a collaborative and consultative approach, we strive to provide a framework of strength and stability for our Centers and Communities. We work to maintain the highest standards of care and service for Residents, families and our valued employees.

We are proud to Offer the following benefits to Part-time (22.5+ hours/week) and Full-time Employees:

• Comprehensive Healthcare Benefits
• Multiple Medical Plans
• Including Pharmacy 
• Including Teladoc
• Multiple Dental Plans 
• Vision Plan
• Health Savings Account (eligibility restrictions apply)
• Flexible Spending Accounts 
• Voluntary Life and AD&D
• Short-Term and Long-Term Disability Plans
• Hospital Indemnity Insurance
• Critical Illness Insurance
• Accident Insurance 
• Whole Life Insurance 
• Medicare Employee Assistance
• Legal Plan 
• Commuter Benefits
• 401k Retirement Plan 
• Employee Assistance Program (available to all employees)
• Paid Time Off
• Vacation
• Sick Plans in accordance with state laws
• Opportunities to advance and grow your career
  
  

If working with people who are dedicated, compassionate, and concerned about their patients is essential to you, then you'll appreciate being a part of our team. We've built a strong reputation on the outstanding level of care that we provide. We have a graciously appointed facility with strong belief in patient care and service; join us at our beautiful facility!

We are an Equal Opportunity Employer

EEO/AA/M/F/DV