Registered Nurse / MDS Coordinator

Overview
We are seeking a highly skilled and detail-oriented Registered Nurse / MDS Coordinator to join our healthcare team. This vital role involves managing comprehensive patient assessments, ensuring compliance with regulatory standards, and coordinating care plans for residents in a clinical setting. The ideal candidate will possess extensive experience with electronic health record (EHR) systems, clinical documentation, and case management, along with a strong understanding of Medicare, Medicaid, and other managed care programs. Prior experience in inpatient, outpatient, or long-term care environments such as nursing homes, trauma centers, or hospice care is highly valued. This position offers an opportunity to contribute to quality patient care while maintaining adherence to HIPAA and NCQA standards.

Duties

• Conduct comprehensive Minimum Data Set (MDS) assessments accurately within required timeframes to support reimbursement and quality metrics.
• Review and analyze medical records and documentation for completeness, accuracy, and compliance with CMS regulations including ICD-10/ICD-9 coding, CPT coding, DRG assignment, and clinical documentation improvement.
• Collaborate with interdisciplinary teams to develop individualized care plans aligned with patient needs and regulatory requirements.
• Manage utilization review processes, including Medicare and managed care documentation review and utilization management activities.
• Ensure all documentation adheres to HIPAA regulations and maintains patient confidentiality at all times.
• Utilize EMR/EHR systems such as Cerner, Athenahealth, eClinicalWorks, or similar platforms for data entry, case management, and reporting purposes.
• Participate in discharge planning, hospice care coordination, and transition of care activities across inpatient and outpatient settings.
• Assist in maintaining compliance with NCQA standards and other accreditation requirements through ongoing documentation review and process improvement initiatives.
• Provide education on clinical documentation best practices to staff members to enhance documentation quality across the organization.

Skills

• Extensive knowledge of medical terminology, anatomy, physiology, and nursing practices across various settings including ICU, PICU, emergency medicine, primary care, pediatrics, and Level I/II trauma centers.
• Proficiency with EMR/EHR systems such as Cerner, Athenahealth, or eClinicalWorks; experience with Epic is preferred.
• Strong understanding of ICD coding (ICD-10/ICD-9), CPT coding, DRG assignment, and case management principles.
• Experience in Medicare/Medicaid billing processes along with utilization review and utilization management procedures.
• Familiarity with clinical documentation improvement initiatives aimed at optimizing reimbursement and quality scores.
• Knowledge of HIPAA regulations related to medical records management and information security.
• Ability to interpret complex medical records accurately while ensuring compliance with NCQA standards.
• Excellent organizational skills with attention to detail for documentation review and medical records management.
• Strong communication skills for effective collaboration within multidisciplinary teams across inpatient and outpatient environments. This position is integral to delivering high-quality patient care through meticulous documentation management while ensuring regulatory compliance in a dynamic healthcare setting.

Job Type: Full-time

Pay: $36.00 - $39.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Flexible schedule
• Free parking
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person

Salary : $36 - $39