Director of Clinical Reimbursement, Skilled Nursing
New
T
Teton.aiSkilled nursing
US RemoteFull-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 of Clinical Reimbursement role at a multi-facility SNF operator.
- Have expert, current knowledge of the RAI Manual, MDS 3.0, PDPM, Section GG, and 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.
- Demonstrate 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.
- Be able to explain complex reimbursement rules to clinicians, engineers and executives.
- Experience translating clinical knowledge into technology, defining requirements or validating software, analytics or AI outputs is a plus.
- Client-facing experience serving SNF operators in consulting, health tech, EHR or software vendor roles is a plus.
- Familiarity with SNF EHRs such as PointClickCare or MatrixCare and MDS data analytics is a plus.
- Experience presenting to operator executives, REITs or senior housing asset owners, and exposure to SNF quality programs, are pluses.
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, including mobility, ADLs, sleep, falls, behaviors and staff interactions, 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 real assessments.
- Monitor CMS rule changes, RAI Manual updates, Five-Star and SNF VBP changes, and state Medicaid case-mix methodologies, and provide product roadmap input.
- Ensure reimbursement-related insights are defensible, audit-ready and supported by documentation; build guardrails against upcoding and flag under-capture.
- Advise on PEPPER, TPE, RAC and survey risk in feature design and positioning.
- Partner with SNF MDS coordinators, DONs, administrators and regional clinical reimbursement leaders to deploy Teton into their 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 with clients, asset owners, partners and at industry events; train commercial, customer success and product teams and develop playbooks, education content and clinical validation protocols.
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