Role overview

Qualifications

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

Responsibilities

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
Completes portions of the electronic MDS-HC form based on diagnoses/information gathered from record review
Conducts routine training sessions for new Care Management staff and relevant Clinical Care Manager

Key facts

Remote from: Indiana (USA), Massachusetts (USA), New Hampshire (USA)
Full time
Senior (5-10 years)
English

Hard skills

Care Management Electronic Health Record Applications Telehealth Care Management Software Organizational Structure

Other skills

Microsoft Excel
Communication
Teamwork
Prioritization

About the company

CareSource

Health Insurance (Payers)

Health Care with Heart. It is more than a tagline; it’s how we do business. CareSource has been providing life-changing health care to people and communities for nearly 30 years and we will continue to be a transformative force in the industry by placing people over profits. CareSource is and will always be members first. Even as we grow, we remember the reason we are here – to make a difference in our members’ lives by improving their health and well-being. Today, CareSource offers a lifetime of health coverage to nearly 2 million members through plan offerings including Marketplace, Medicare Advantage and Medicaid. With our team of 4,000 employees located across the country, we continue to clear a path to better life for our members. Visit the "Life" section to see how we are living our mission in the states we serve. CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity, genetic information, protected veteran status or any other characteristic protected by applicable federal, state or local law. If you’d like more information about your EEO rights as an applicant under the law, please click here: https://www.eeoc.gov/employers/upload/poster_screen_reader_optimized.pdf and here: https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf Si usted o alguien a quien ayuda tienen preguntas sobre CareSource, tiene derecho a recibir esta información y ayuda en su propio idioma sin costo. Para hablar con un intérprete, Por favor, llame al número de Servicios para Afiliados que figura en su tarjeta de identificación. 如果您或者您在帮助的人对 CareSource 存有疑问，您有权免费获得以您的语言提供的帮助和信息。如果您需要与一位翻译交谈，请拨打您的会员 ID 卡上的会员服务电话号码。

Company details

Company typeLarge

IndustryHealth Insurance (Payers)

Company size1001 - 5000

Links

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Job description

Job Summary:

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