RN MDS Reviewer Job Description: Supporting MassHealth Compliance

A remote Registered Nurse (RN) MDS Reviewer position is available for candidates residing in Massachusetts to manage the completion and submission of Minimum Data Set (MDS) documentation to MassHealth. The role focuses on ensuring clinical data accuracy for state reimbursement and regulatory compliance.

The Minimum Data Set is a standardized clinical assessment tool used in skilled nursing facilities to determine a patient’s functional status and care needs. According to the job requirements, the RN MDS Reviewer is responsible for the successful submission of these records to MassHealth, the state’s Medicaid program.

Requirements for the RN MDS Reviewer Role

The position requires the candidate to hold a valid Registered Nurse license. A primary condition of employment is that the nurse must reside within the state of Massachusetts, despite the remote nature of the work.

The core responsibility involves reviewing MDS submissions to ensure they meet the specific guidelines set by MassHealth. This process is critical for facilities to secure proper funding and maintain compliance with state health regulations.

MDS Compliance and MassHealth Submissions

The MDS process serves as the basis for the Patient Driven Payment Model (PDPM), which determines the reimbursement rates for skilled nursing facilities. Errors in MDS coding or submission can lead to payment delays or audits by state regulators.

By reviewing these sets, the RN MDS Reviewer verifies that the clinical documentation supports the coded levels of care. This oversight prevents under-coding, which loses revenue, and over-coding, which can trigger legal or financial penalties from MassHealth.