Vice President of Clinical Reimbursement

Overview

The Director of Clinical Reimbursement provides leadership and oversight for all clinical reimbursement functions across multiple skilled nursing facilities. This role ensures accurate, compliant, and timely Medicare and Medicaid reimbursement by overseeing the MDS process, PDPM performance, NFLOC determinations, and regulatory readiness.

The Director of Clinical Reimbursement partners closely with Operations, Finance, Compliance, and Clinical Leadership to optimize reimbursement outcomes while maintaining clinical integrity and regulatory compliance.

• Provide leadership and oversight of clinical reimbursement processes across assigned facilities

• Ensure accurate, timely, and compliant completion of all Medicare and Medicaid MDS documentation

• Serve as the organization’s subject matter expert for MDS, PDPM, NFLOC, and reimbursement regulations

• Oversee interdisciplinary collaboration among nursing, therapy, dietary, social services, restorative, and physician services

• Support, mentor, and guide MDS Coordinators and regional reimbursement staff

• Develop and deliver education, onboarding, and ongoing training for staff involved in the MDS process

• Ensure timely implementation of regulatory and reimbursement changes across all facilities

• Monitor facility reimbursement performance and identify trends, risks, and improvement opportunities

• Advise Administrators and leadership on abnormal patterns or compliance concerns

• Lead and manage CMS audits, including TPE and ADR reviews

• Support regulatory survey readiness and participate in surveys as needed

• Prepare and present reimbursement and performance reports to leadership

• Travel to facilities as needed to provide oversight, training, and support

• Maintain compliance with all federal, state, and payer requirements

• Demonstrate professionalism, integrity, compassion, and a commitment to quality care

• Perform other duties as assigned

• Current, active, unencumbered Registered Nurse (RN) license

• Extensive experience in skilled nursing and/or rehabilitation settings

• Expert knowledge of the MDS process and PDPM reimbursement model

• Minimum of 3 years of experience as an MDS Coordinator

• Experience in a multi-site or regional leadership role preferred

• RAC-CT or RNAC certification preferred

• Strong leadership, training, and communication skills