RN MDS Reviewer

Position Summary:

Commonwealth Care Alliance's (CCA) Care Planning Unit (CPU) is primarily responsible for developing and ensuring adherence to high quality, member-centric care plans through timely execution of community-based assessments for CCA members and ongoing tracking and monitoring.

The RN MDS Reviewer is a member of the Minimum Data Set (MDS) Clinical Review team of the Care

Planning Unit. The RN MDS Reviewer supports successful completion and submission of the MDS to

MassHealth. S/he 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 Care Planners to facilitate optimal documentation and, where necessary, rating category assignment. S/he also supports the Proxy MDS Reviewer (LPN) in completing Proxy MDS submissions for members who cannot be reached for assessment.

The RN MDS Reviewer reports to the Manager, MDS Clinical Reviews.

Essential Duties & Responsibilities:

• Reviews MDS forms completed by Care Planners and relevant Care Partners for completion and accuracy.
• Provides feedback to Care Planners and relevant Care Partners 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 Planning staff and relevant Care Partners to drive high quality, consistent MDS assessments.
• Conducts reviews in a timely way in accordance with all CCA 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.
• Additional MDS-related tasks as required by supervisor.

Required Education:

• Associate's Degree in Nursing

Desired Education:

• Bachelor's Degree in Nursing

Required Licensing:

• Registered Nurse with current Massachusetts license in good standing

Required Experience:

• 5+ years
• 5 years experience working in acute or long term care setting

Desired Experience:

• Home care or care management experience preferred
• Experience working with MassHealth populations preferred
• Experience with care management platform strongly preferred

Required Knowledge, Skills & Abilities:

• Ability to communicate effectively with clinical staff and physician offices
• Good technology skills, including use of electronic health records and Microsoft Excel
• Able 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.

Desired Knowledge, Skills & Abilities:

• Experience with medical records review preferred
• Knowledge of MDS strongly preferred

Languages:

• English