Vice President (VP) of Clinical Reimbursement, RNLocation: Louisville, Kentucky
Job Type: Full-Time | Exempt
Travel: Up to 50-75%
Salary: $180k
Position OverviewWe are seeking a strategic, results-driven
Vice President of Clinical Reimbursement (RN) to lead and optimize reimbursement operations across our organization. This executive role partners closely with clinical and operational leaders to ensure accurate reimbursement, regulatory compliance, and top-tier quality outcomes.
You'll serve as the
go-to expert in RAI, PDPM, and Case Mix, driving education, performance improvement, and financial integrity across multiple skilled nursing facilities.
What You'll Do- Lead & Influence
- Serve as the clinical reimbursement authority across all facilities
- Guide MDS Coordinators and regional teams on RAI, PDPM, and Case Mix
- Drive Performance
- Monitor Medicare and Case Mix performance metrics
- Identify trends and implement strategies to maximize reimbursement
- Elevate Quality
- Partner with Regional Nurse Consultants to improve:
- Quality Measures (QM)
- CMS Five-Star Ratings
- Support interdisciplinary teams (IDT) with education and systems development
- Ensure Compliance & Accuracy
- Oversee RAI process compliance with federal and state regulations
- Support accurate coding, billing, and claims submission
- Lead Improvement Initiatives
- Drive QAPI efforts including:
- Trend analysis
- Root Cause Analysis
- Solution implementation and tracking
- Support Survey Readiness
- Participating in mock surveys and regulatory preparation
- Ensure facilities are always audit-ready
What You BringRequired:- Active Registered Nurse (RN) license
- Associate or bachelor's degree in nursing
- 3+ years of hands-on experience with the RAI process
- Strong expertise in:
- PDPM reimbursement model
- State Case Mix systems
- Deep understanding of long-term care regulations and compliance
Preferred:- Multi-facility or regional experience
- Experience improving CMS Five-Star ratings
Key Competencies- Executive-level leadership and decision-making
- Strong analytical and problem-solving skills
- Exceptional communication across clinical and corporate teams
- Highly organized with ability to manage multiple priorities
- Self-directed, proactive, and results-oriented
- Adaptable in fast-paced healthcare environments
Technical Skills- Microsoft Office (Excel, Word, PowerPoint)
- Data analysis and reporting tools preferred
Work Environment- Dynamic, fast-paced skilled nursing environment (24/7 operations)
- Travel required across multiple facilities
- Occasional extended hours and weekends based on business needs
Physical Requirements- Ability to sit, stand, and walk for extended periods
- Ability to use standard office equipment
- Strong verbal and written communication skills
- Ability to remain composed under pressure
Ready to Make an Impact?If you're a clinical reimbursement leader ready to drive results, improve quality outcomes, and influence strategy at the executive level-we want to hear from you. Apply today and help shape the future of clinical reimbursement excellence.
