CMI Specialist - LPN

The LPN CMI Specialist supports accurate Pennsylvania Medicaid Case Mix Index (CMI) reimbursement through on-site resident evaluations, completion of assigned User-Defined Assessments (UDAs), clinical documentation review, MDS coding support, interdisciplinary collaboration, and staff education. The specialist works with facility leadership and MDS teams to ensure that resident care needs and services are accurately assessed, documented, and reflected in MDS coding in accordance with applicable CMS, RAI Manual, Pennsylvania Medicaid Case Mix, and facility requirements. Activities are performed within the LPN scope of practice with RN oversight.

• →Conduct scheduled on-site resident evaluations at assigned facilities, including observation of functional performance, review of clinical records, and discussion with direct-care staff to identify documentation or coding discrepancies.
• →Complete assigned User-Defined Assessments (UDAs) accurately and timely in the facility electronic health record; reconcile findings with nursing documentation and communicate significant changes or concerns to the RN/MDS Coordinator.
• →Monitor ADL documentation and coding for accuracy and consistency with observed resident performance, staff interviews, care plans, and applicable MDS/RAI coding instructions; identify discrepancies and coordinate corrections through facility processes.
• →Provide one-on-one, on-site coaching to nursing assistants, nurses, MDS Coordinators, Social Services Directors and other appropriate staff on ADL documentation, supporting clinical records, interviewing practices, and Case Mix-related assessment practices.
• →Assist with developing and delivering structured, on-site education programs, which may include orientation, refresher training, targeted in-services, case-based examples, and competency follow-up based on audit findings.
• →Monitor Pennsylvania Medicaid CMI performance for assigned facilities; analyze quarterly CMI reports, identify trends, and recommend compliant improvement opportunities.
• →Review MDS assessments for coding accuracy, Case Mix classification, and consistency with supporting documentation; communicate recommended changes to the responsible MDS clinician.
• →Audit documentation supporting ADLs, restorative nursing, extensive services, special care, clinically complex, behaviors, cognition, depression, nutrition, respiratory services, and skin conditions.
• →Follow-up on concurrent and retrospective documentation audits to verify that identified issues have been addressed.
• →Monitor applicable Pennsylvania Medicaid picture-date requirements, resident inclusion, eligibility, and Case Mix qualification criteria.
• →Collaborate with Directors of Nursing, MDS Coordinators, rehabilitation, direct-care teams, and practitioners to improve documentation completeness and specificity.
• →Assist with facility-specific CMI action plans, Medicaid audit preparation, survey readiness, and tracking of corrective actions.
• →Prepare timely reports summarizing on-site evaluations, UDA completion, ADL coding findings, education delivered, audit outcomes, and CMI/KPI trends.
• →Maintain compliance with CMS, the RAI Manual, Pennsylvania Medicaid Case Mix requirements, privacy standards, and applicable LPN practice limitations; escalate matters requiring RN assessment or clinical judgment.
• →Other duties as assigned

• Current, active Pennsylvania Licensed Practical Nurse (LPN) license in good standing.
• Minimum 3–5 years of skilled nursing facility experience; at least 2 years of MDS, clinical reimbursement, or Case Mix-related experience preferred.
• Working knowledge of MDS 3.0, RAI Manual, Pennsylvania Medicaid Case Mix methodology, ADL coding, and skilled nursing documentation.
• Experience completing electronic UDAs, conducting resident observations, auditing documentation, and providing direct staff education.
• Strong analytical, interpersonal, organizational, presentation, and written communication skills.
• Ability to travel between assigned facilities for on-site visits
• Preferred: RAC-CT certification, consulting or multi-facility experience, and proficiency with PointClickCare, MatrixCare, IntelliLogix, or SimpleLTC.

Frequent computer use, travel to assigned Pennsylvania skilled nursing facilities, and ability to conduct on-site resident observations, chart reviews, staff interviews, and educational sessions. Must be able to meet facility access and safety requirements.

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• Accurate and timely on-site resident evaluations and UDA completion
• Improved ADL documentation and MDS coding accuracy; fewer repeat discrepancies
• Completion of one-on-one coaching and structured education with demonstrated staff competency
• Timely closure of audit findings and corrective actions
• Accurate and complete supporting clinical documentation
• Improved, compliant Medicaid CMI performance and reimbursement capture
• Timely reporting and successful Medicaid audit outcomes