Job DescriptionPosition Title: Regional Director of Clinical Reimbursement
Employment Type: Full-Time with required travel
Role Overview: The Regional Director of Clinical Reimbursement is responsible for the oversight, assessment, education, and implementation of programs relating to the Medicare Prospective Payment System (PPS), Medicaid Case Mix Index (CMI), and MDS processes across multiple regional facilities.
This position requires frequent travel to provide facility MDS coordinators with on-site ongoing support and training. You will ensure compliance with evolving CMS regulations and optimize clinical reimbursement under the Patient-Driven Payment Model (PDPM).
Key Duties and Responsibilities:- Multi-Facility Support & Oversight: Provide direct oversight, educational, and technical support for center-based MDS, OBRA, and PPS coordinators. Monitor caseloads to prevent reimbursement denials and ensure financial optimization.
- Training & Education: Create custom training programs to promote team efforts and educate staff on common coding errors, supportive documentation, and the most prevalent PDPM and Case Mix Index (CMI) missed opportunities.
- Compliance & Quality Assurance: Prevent MDS-related survey deficiencies and manage medical review risks. Maintain up-to-date knowledge of the MDS RAI manual, Quality Measures (QM), and SNF QRP/VBP guidelines.
- Clinical Accuracy under PDPM: Proactively assess and verify that clinical conditions, such as behavioral symptoms, depression (PHQ 2-9), isolation, and Section GG self-care/mobility scores, are captured accurately to elevate Nursing and NTA case-mix reimbursement.
- Interdisciplinary Collaboration: Work closely with facility leadership, therapy, dietary, social work, and providers to ensure accurate documentation, ICD-10 coding specificity, and effective person-centered care planning.
Required Qualifications & Skills:- Certifications: Active Utah RN license required with compact license preferred. RAC-CT credential strongly preferred.
- Experience: Minimum of three years experience in a long-term care setting managing Medicare and Medicaid MDS, CMI, care planning, Quality Measures, QRP/VBP outcomes, and state performance programs (i.e., UPL). Previous training or leadership experience at a regional or corporate level is highly desired.
- Expertise: Strong knowledge of MDS 3.0, PDPM and state specific CMI structures, accurate ICD-10 coding, and skilled nursing documentation requirements.
- Must possess an a naturally friendly, pleasant, and good-natured personality, critical thinking skills, the ability to perform under pressure, and meticulous professional work ethics.
- Experience training, mentoring, and supporting interdisciplinary teams.
- Strong audit, compliance review, and reimbursement analysis skills.
- Ability to manage multiple priorities across multiple facilities.
- Experience with EMR, preferably PointClickCare, clinical assessments, and care planning
- Solid communication, teamwork, adaptability, problem solving, and time management skills
