Director of Clinical Reimbursement – Skilled Nursing

This is a fully remote position, open to applicants in United States.

📋 Description

• Act as Teton's expert on the RAI Manual, MDS 3.0, PDPM, Section GG, Care Area Assessments, and Quality Measures.

• Align platform observations—including mobility, ADLs, sleep, falls, behaviors, and staff interactions—with MDS items, look-back periods, and PDPM components.

• Establish clinical and reimbursement requirements in collaboration with product, data science, and engineering teams.

• Draft specifications, assess models, and verify outputs against actual assessments.

• Keep track of CMS rule modifications, RAI Manual revisions, Five-Star and SNF VBP updates, and state Medicaid case-mix methodologies.

• Transform regulatory and reimbursement modifications into input for the product roadmap.

• Guarantee that reimbursement-related insights are defensibly structured, audit-ready, and backed by documentation.

• Create safeguards to prevent upcoding and to identify under-capture.

• Provide guidance on PEPPER, TPE, RAC, and survey risk during feature design and positioning.

• Collaborate with SNF operators' MDS coordinators, DONs, administrators, and regional clinical reimbursement leaders to integrate Teton into workflows.

• Measure the impact on case-mix index, PDPM rates, Medicaid CMI, quality measures, and Five-Star ratings.

• Construct the ROI case for sales and renewals.

• Represent Teton at industry events and with clients, asset owners, and partners.

• Educate commercial, customer success, and product teams on SNF reimbursement principles.

• Create playbooks, educational content, and clinical validation protocols as Teton expands across US portfolios.

⛳️ Requirements

• Over 5 years of direct experience in national-level MDS and SNF revenue management, such as a corporate or multi-region Director/VP of Clinical Reimbursement role at a multi-facility SNF operator.

• In-depth, up-to-date knowledge of the RAI Manual, MDS 3.0, PDPM, Section GG, and Medicare Part A and Medicaid case-mix reimbursement.

• Familiarity with state Medicaid case-mix systems across various states and awareness of regional practice differences.

• Proven history of enhancing MDS accuracy, case-mix capture, and reimbursement results across a portfolio of facilities.

• Strong understanding of compliance and audit risks (PEPPER, TPE, RAC, survey) and a dedication to accurate, defensible coding.

• Active RN license (or LPN/LVN with equivalent senior experience).

• RAC-CT, RAC-CTA, or comparable AAPACN certification.

• Effective communicator capable of elucidating complex reimbursement regulations to clinicians, engineers, and executives alike.

🏝️ Benefits

• Competitive salary.

• Equity opportunities.

• Comprehensive benefits.

• Chance to shape how AI enhances clinical reimbursement in skilled nursing.

• Direct impact on product strategy at a rapidly growing, venture-backed company.

• Mission centered on improving resident outcomes, alleviating caregiver burden, and creating more predictable operator operations.