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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in MDS/clinical reimbursement, RAI Manual compliance, and quality improvement initiatives within multi-facility healthcare settings. Proficient in data analysis, program oversight, and effective communication with clinical teams to enhance resident care and operational efficiency.
Highest-signal resume keywords
Active Florida RN LicenseMDS/Clinical Reimbursement ExperienceExpert Knowledge of RAI ManualStrong Excel/Data SkillsKnowledge of Florida Medicaid PPS
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
MDS CodingData AnalysisClinical Documentation ReviewQuality Improvement ProjectsInfection Prevention ProgramsBehavioral Care PlanningPsychotropic StewardshipResident Care ObservationPerformance Improvement MetricsStaffing Measures Improvement
Soft Skills
Influencing Without AuthorityCoaching StaffFamily EngagementCommunication SkillsTeam Collaboration
Tools & Technologies
CASPER ReportsQAPI ToolsExcelPayroll SystemsClinical Reporting Software
Industry Keywords
CMS ComplianceAHCA RulesFive-Star Quality RatingQIP ScoringManaged Care MDS Accuracy
About the role
Key responsibilities & impact- Partner with DONs, Medical Directors, and consultant pharmacists on psychotropic stewardship, behavioral care planning, and non-pharmacologic dementia approaches
- Lead falls-with-injury, pressure injury, and infection-prevention programs
- Strengthen restorative nursing, continence programs, and mobility plans
- Reduce avoidable hospitalizations through early change-of-condition recognition, physician communication, and family engagement
- Drive influenza vaccination and support restraint-free care
- Run QAPI performance improvement projects with measurable goals
- Provide care teams with resident-level reports and specific clinical next steps
- Round on units to observe care, coach staff, and confirm care plans match bedside practice
- Own facility staffing measures and drive improvement to the next percentile
- Work with HR and nursing leaders on RN retention, onboarding, and competency
- Validate PBJ submissions and cost report staffing hours with payroll and finance
- Audit MDS coding for accuracy and ensure diagnoses and exclusions are supported in the clinical record
- Review CASPER/QM reports monthly and complete pre-snapshot data accuracy reviews
- Ensure compliance with the RAI Manual, CMS and AHCA rules, and company compliance policy
- Maintain facility-level scorecards across all 16 QIP measures
- Set quarterly point plans with Administrators and DONs
- Target near-miss measures and year-over-year improvement credits
- Own credentialing roadmaps for Five-Star, Joint Commission, AHCA/NCAL National Quality Award, and Florida Gold Seal
- Track AHCA rule changes and the 2027 rebase
- Support Medicare PDPM and managed care MDS accuracy
Requirements
What you’ll need- Active Florida RN license
- 3+ years of multi-facility MDS/clinical reimbursement experience
- Expert knowledge of the RAI Manual, CMS QMs, and Five-Star
- Working knowledge of Florida Medicaid PPS and QIP scoring
- Strong Excel/data skills
- Ability to influence without direct authority
- Ability to sit for extended periods while performing data analysis, documentation reviews, reporting, and administrative duties
- Ability to stand and walk regularly throughout healthcare facilities to conduct clinical rounds and observe resident care
- Ability to travel between assigned facilities for meetings, audits, training, and program oversight
- Ability to use a computer, telephone, and other office equipment for extended periods
- Ability to occasionally bend, reach, and lift or carry light materials while conducting facility visits and clinical reviews
Benefits
Comp & perks- Equal opportunity employer
- Full-time employment