MDS Coordinator/Case Manager

Job Summary

We are seeking a dedicated and detail-oriented MDS Coordinator/Case Manager to join our healthcare team. In this vital role, you will coordinate and oversee the Minimum Data Set (MDS) assessments, ensuring accurate clinical documentation and compliance with federal and state regulations. Your expertise will support optimal patient care, facilitate effective case management, and ensure reimbursement accuracy through precise coding and documentation. This position offers an exciting opportunity to impact patient outcomes positively while working within a dynamic healthcare environment that values professionalism, collaboration, and continuous improvement.

Duties

• Lead comprehensive MDS assessments for long-term care residents, ensuring timely completion in accordance with CMS (Centers for Medicare and Medicaid Services) guidelines.
• Review medical records, clinical documentation, and care plans to verify accuracy and completeness against documentation standards.
• Collaborate with interdisciplinary teams including nursing, therapy, social work, and physicians to gather necessary information for accurate MDS coding.
• Ensure compliance with HIPAA (Health Insurance Portability and Accountability Act), state healthcare regulations, and NCQA (National Committee for Quality Assurance) standards.
• Utilize EMR/EHR systems such as Cerner, eClinicalWorks, or Athenahealth to document assessments, review records, and manage patient data efficiently.
• Perform utilization management and review medical necessity for services using CPT coding, ICD-9/ICD-10 coding systems, DRG (Diagnosis-Related Group) assignments, and medical management principles.
• Support discharge planning, hospice care coordination, and outpatient or inpatient transitions to optimize patient care continuity.
• Maintain detailed documentation review logs, audit trails, and compliance reports to support clinical documentation improvement initiatives.

Experience

• Proven experience in long-term care facilities such as nursing homes or skilled nursing facilities with familiarity of long-term care regulations.
• Strong background in clinical documentation standards, medical terminology, anatomy, physiology, and healthcare policies related to Medicare and Medicaid.
• Knowledge of utilization review processes, medical coding (CPT, ICD-9/10), DRG assignment, and health regulation policies is essential.
• Familiarity with managed care processes.
• Excellent organizational skills combined with the ability to interpret complex medical records while adhering to HIPAA guidelines.
• Previous experience in discharge planning or case management within outpatient or inpatient environments will support success in this position.

Join our team to make a meaningful difference in patient lives through expert clinical documentation management! We are committed to fostering a collaborative environment that encourages professional growth while ensuring compliance with all relevant healthcare standards.

Pay: $28.96 - $36.06 per hour

Expected hours: 40.0 per week

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person