Director of Clinical Reimbursement, Skilled Nursing
New
T
TetonSkilled nursing
Remote USFull-TimeDirector
Salary not disclosed
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Job Details
- Experience
- 5+ years of direct involvement in national-level MDS and SNF revenue oversight
Requirements
- Bring 5+ years of direct involvement in national-level MDS and SNF revenue oversight, such as a corporate or multi-region Director/VP role at a multi-facility SNF operator.
- Have expert, current knowledge of the RAI Manual, MDS 3.0, PDPM and Section GG.
- Understand Medicare Part A and Medicaid case-mix reimbursement.
- Have working knowledge of state Medicaid case-mix systems across multiple states and regional practice differences.
- Show a track record of improving MDS accuracy, case-mix capture and reimbursement outcomes across a portfolio of facilities.
- Have a strong grasp of compliance and audit risk, including PEPPER, TPE, RAC and survey risk, and a commitment to accurate, defensible coding.
- Hold an active RN license, or an LPN/LVN license with equivalent senior experience.
- Hold RAC-CT, RAC-CTA or equivalent AAPACN certification.
- Travel to key clientele as needed (10%).
- Nice to have: experience translating clinical knowledge into technology by defining requirements or validating software, analytics or AI outputs.
- Nice to have: client-facing experience in consulting, health tech, EHR or software vendor work serving SNF operators.
- Nice to have: familiarity with SNF EHRs such as PointClickCare or MatrixCare and MDS data analytics.
Responsibilities
- Serve as the subject-matter expert on the RAI Manual, MDS 3.0, PDPM, Section GG, Care Area Assessments and Quality Measures.
- Map platform observations to MDS items, look-back periods and PDPM components.
- Define clinical and reimbursement requirements with product, data science and engineering; write specifications, review models and validate outputs against assessments.
- Monitor CMS rules, RAI Manual updates, Five-Star and SNF VBP changes, and state Medicaid case-mix methodologies, and translate them into product roadmap input.
- Ensure reimbursement insights are defensible, audit-ready and supported by documentation; build safeguards against upcoding and under-capture.
- Advise on PEPPER, TPE, RAC and survey risk in feature design and positioning.
- Partner with SNF operators' MDS coordinators, DONs, administrators and regional clinical reimbursement leaders to deploy the platform into workflows.
- Quantify impact on case-mix index, PDPM rates, Medicaid CMI, quality measures and Five-Star ratings, and build ROI cases for sales and renewals.
- Represent Teton at industry events and with clients, asset owners and partners.
- Train commercial, customer success and product teams, and develop playbooks, education content and clinical validation protocols.
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