VP of Clinical Reimbursement, Skilled Nursing

The role

The Director of Clinical Reimbursement, Skilled Nursing will serve as a subject-matter expert on the RAI process, MDS 3.0, and PDPM. This person will translate reimbursement expertise into product requirements and partner with SNF operators to deploy the platform.

What you will do

• Serve as subject-matter expert on the RAI Manual, MDS 3.0, PDPM, Section GG, Care Area Assessments and Quality Measures
• Map platform observations to MDS items, look-back periods and PDPM components
• Define clinical and reimbursement requirements with product, data science and engineering
• Monitor CMS rule changes, RAI Manual updates, Five-Star and SNF VBP changes, and state Medicaid case-mix methodologies
• Ensure reimbursement-related insights are defensible and audit-ready
• Build guardrails to prevent upcoding and flag under-capture
• Advise on PEPPER, TPE, RAC and survey risk
• Partner with SNF operators to deploy Teton into workflows
• Quantify impact on case-mix index, PDPM rates, Medicaid CMI, quality measures and Five-Star ratings
• Train commercial, customer success and product teams on SNF reimbursement fundamentals

Required qualifications

• 5+ years of direct involvement in national-level MDS and SNF revenue oversight
• Expert, current knowledge of the RAI Manual, MDS 3.0, PDPM, Section GG, and Medicare Part A and Medicaid case-mix reimbursement
• Working knowledge of state Medicaid case-mix systems across multiple states
• Track record of improving MDS accuracy, case-mix capture and reimbursement outcomes across a portfolio of facilities
• Strong grasp of compliance and audit risk (PEPPER, TPE, RAC, survey)
• Active RN license (or LPN/LVN with equivalent senior experience)
• RAC-CT, RAC-CTA or equivalent AAPACN certification
• Clear communicator

Nice to have

• Experience translating clinical knowledge into technology
• Client-facing experience in a consulting, health tech, EHR or software vendor role serving SNF operators
• Familiarity with SNF EHRs (e.g., PointClickCare, MatrixCare) and MDS data analytics
• Experience presenting to operator executives, REITs or other senior housing asset owners
• Exposure to SNF quality programs (Five-Star, SNF QRP, SNF VBP) and their link to reimbursement

Benefits

• Competitive salary
• Equity
• Benefits

About the company

Teton is building the predictive intelligence layer for senior care using an AI and computer vision platform. The company is used by more than 10,000 care staff across the US and Europe.