Job Description

The RN MDS Reviewer supports successful completion and submission of the MDS (Minimum Data Set) to MassHealth. This role will examine MDS assessments prepared by clinicians to ensure completeness, accuracy and appropriate explanation of functional status and related clinical findings. Where gaps occur, the RN MDS Reviewer provides feedback to Clinical Care Manager to facilitate optimal documentation and, where necessary, rating category assignment. This role also supports the Proxy MDS Reviewer (LPN) in completing Proxy MDS submissions for members who cannot be reached for assessment.

Essential Functions:

• Reviews MDS forms completed by Clinical Care Manager for completion and accuracy.
• Provides feedback to Clinical Care Manager and relevant members of Care Management team on areas where insufficient documentation is found or where rating category assignment is inaccurate.
• Completes portions of the electronic MDS-HC form based on diagnoses / information gathered from record review.
• Prepares printed MDS forms for data entry.
• Conducts routine training sessions for new Care Management staff and relevant Clinical Care Manager to drive high quality, consistent MDS assessments.
• Conducts reviews in a timely way in accordance with all timeliness and quality standards.
• Provide clinical care to members via telehealth technologies (video, chat, etc.) for a clinically appropriate clinical care and care management services.
• Performs any other job related duties as requested.

Education and Experience:

• Associates degree in nursing is required
• Bachelor's degree in nursing is preferred
• Five (5) years of experience working in an acute or long-term care setting required
• Experience working with MassHealth populations preferred
• Experience with care management platform preferred

Competencies, Knowledge and Skills:

• Ability to communicate effectively with clinical staff and physician offices
• Good technology skills, including use of electronic health records and Microsoft Excel
• Knowledge of MDS strongly preferred
• Ability to function effectively as part of a team
• Ability to organize and prioritize work independently
• Deep familiarity with medical terminology
• Willing to learn and utilize telehealth technologies (video, chat, etc.), when appropriate, for a variety of clinical care and care management services

Licensure and Certification:

• Current, unrestricted Registered Nurse (RN) license in state of Massachusetts in good standing is required

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Travel is not typically required

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

Brand=Commonwealth Care Alliance