Regional MDS Consultant

Job Description

Job Description

Position Summary

The Regional MDS Consultant serves as a clinical reimbursement leader responsible for supporting skilled nursing facilities in achieving accurate assessment completion, regulatory compliance, optimal reimbursement, and exceptional resident outcomes. This role partners closely with facility leadership, MDS Coordinators, clinical teams, and corporate leadership to ensure the integrity of the MDS process, PDPM accuracy, care planning, and clinical documentation practices.

The Regional MDS Consultant provides ongoing education, auditing, mentorship, and operational support to assigned facilities while promoting Evercare's commitment to compassionate care, regulatory excellence, and financial stewardship.

• Provide oversight and support for the accurate and timely completion of all MDS assessments, including OBRA, PPS, Significant Change, Significant Correction, Entry, Discharge, and other required assessments.

• Monitor PDPM performance and reimbursement opportunities while ensuring compliance with federal and state regulations.

• Conduct routine audits of MDS assessments, supporting documentation, care plans, and clinical records to ensure accuracy and reimbursement integrity.

• Review clinical documentation to ensure appropriate capture of diagnoses, services, functional outcomes, and reimbursement drivers.

• Validate coding accuracy and identify opportunities for reimbursement optimization while maintaining regulatory compliance.

• Assist facilities with MDS scheduling, assessment completion timelines, and submission requirements.

• Ensure timely electronic transmission of assessments and resolution of validation errors.

• Serve as a clinical reimbursement resource for Administrators, Directors of Nursing, MDS Coordinators, and interdisciplinary teams.

• Provide ongoing education and mentoring related to MDS, PDPM, care planning, documentation standards, and reimbursement practices.

• Assist facilities in developing and implementing corrective action plans related to audit findings, survey concerns, or reimbursement opportunities.

• Support onboarding and development of newly hired MDS Coordinators and clinical reimbursement personnel.

• Facilitate regular reimbursement and clinical documentation reviews with facility leadership teams.

• Ensure compliance with CMS regulations, state requirements, and company policies related to resident assessment and reimbursement.

• Monitor quality measures and collaborate with facility teams to improve outcomes and regulatory performance.

• Assist facilities in preparing for surveys, audits, focused reviews, ADRs, TPEs, and other regulatory inquiries.

• Support implementation of best practices designed to improve clinical outcomes, survey readiness, and reimbursement accuracy.

• Identify trends and opportunities for process improvement across assigned facilities.

• Partner with nursing, therapy, dietary, social services, activities, and physician teams to ensure comprehensive resident assessments.

• Support the development and review of individualized care plans that reflect resident needs, goals, and services provided.

• Participate in care conferences and interdisciplinary meetings as needed.

• Assist facilities in evaluating resident clinical needs and reimbursement opportunities during admissions and significant clinical changes.

• Travel routinely to assigned facilities to provide onsite support, education, and auditing.

• Participate in regional and corporate meetings as requested.

• Assist with special projects, initiatives, and other duties as assigned.

• Current, unrestricted Registered Nurse (RN) license.

• Bachelor's Degree in Nursing preferred.

• Minimum of five years of experience in skilled nursing, long-term care, or post-acute care.

• Minimum of three years of MDS, PDPM, or clinical reimbursement experience.

• RAC-CT certification preferred.

• Extensive knowledge of MDS 3.0, PDPM, Medicare, Medicaid, and long-term care regulations.

• Strong understanding of care planning, quality measures, and reimbursement systems.

• Excellent communication, organizational, analytical, and leadership skills.

• Ability to educate, mentor, and influence clinical teams across multiple facilities.

• Proficiency with electronic health records and MDS software systems.

• Valid driver's license and reliable transportation.

The physical demands described here are representative of those necessary to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform essential job functions.

• Ability to move throughout healthcare facilities for extended periods.

• Ability to sit, stand, walk, bend, and reach throughout the workday.

• Ability to lift, push, pull, and carry up to 50 pounds occasionally.

• Ability to travel throughout the assigned region as needed, including overnight travel when necessary.

• Travel requirement: up to 75%.