MDS Coordinator / Case Manager

Vista Senior Living Management is a dedicated branch tailored specifically for senior communities. Specializing in Assisted Living, Memory Care, and Independent Living services, Vista ensures unparalleled personalized care and 24-hour assistance for our residents, ensuring a consistent and exceptional experience. Our unwavering mission is to provide an outstanding care experience rooted in genuine compassion and humble dedication to our senior’s well-being. With 16 communities spanning across multiple states. Vista Senior Living specializes in Assisted Living and Memory Care services. Our dedicated team ensures a nurturing environment where seniors thrive and find joy in every moment.

Position : MDS Coordinator / Nurse Case Manager

Candidates must be well-versed in MDS, RAI, and Clinical Reimbursement. Prior experience with Point Click Care (PCC) is preferred.

Essential Duties and Responsibilities :

Coordinates resident assessment (MDS) according to RAI process and standards

Conduct MDS interviews as assigned- Nursing and Social Services.

Complete the MDS in accordance with RAI process and standards.

Collaborate and educate IDT on RAI needs in regards to MDS completions, Reimbursement, Quality Measures and other areas as needed.

Facilitates, coordinates and participates in care conferences and regular care plan updates.

Educates staff as needed to ensure appropriate documentation needs related to resident assessment

Prepares for and conducts Utilization review meetings with the IDT.

Participates in ICD 10 coding for new admissions and subsequent diagnosis changes

Coordinates and converses with Managed Care Insurance organization to ensure / meet authorization requirements are met. Providing prompt and detailed communication.

Manages communication and processes as needed with ACOs and QIO appeals.

Serve as the point person for communication and collaboration needs regarding resident DC planning with any applicable external customer : i.e. Community case managers, Home Health agencies, DME providers, Family members, receiving facilities.

Participate in company Quality Review processes including QAPI meetings and monthly Quality Assurance / QM metric meetings.

Deliver denial letters – NOMNCs and SNF ABNs in accordance with CMS guidelines.

Collaborates in Grievance tracking and follow up.

Prepare for and actively participate in Morning Stand up, clinical meetings and end of day wrap up meetings.

Participate in monthly Triple check meetings.

Manage facility Psychotropic and behavior program, including but not limited to collaboration with MDs and pharmacy on GDRs, care planning, documentation and evaluation of appropriateness of medication use and nonpharmacological approaches.

Other duties as assigned or as may be required.

Qualifications :

Current license as a LPN / RN and able to practice in IL

Strong knowledge of the MDS process-

2+ years’ experience preferred.

Strong knowledge of ICD 10 coding / coding guidelines, Medicare Chapter 8 Manual, RAI Manual

Preferably with social work experience or an understanding of discharge planning.

Possesses good organization skills

Excel document, Teams, or Zoom platform experience a plus!

Excellent in written and oral communication skills.

Valid CPR certification (willingness to obtain)

Keywords : MDS, Reimbursement. RAI, Minimum Data Set, Medicare, Insurance, Medicaid, RNAC, AANAC, RAC-CT, RNAC-CE