Director of Clinical Reimbursement – Skilled Nursing

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🕒 Novembro 3

🇺🇸 Estados Unidos – Remoto (EUA)

⏰ Tempo Integral

🔴 Especialista

👔 Diretor

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Teton

SiteLinkedInTodas as Vagas

51 - 200 funcionários

🏥 Saúde

🤖 Inteligência Artificial

🔧 Hardware

💰 $20.000.000 Series A - Teton em 2025-09

Healthcare • Artificial Intelligence • Hardware

A Teton é uma empresa de tecnologia em saúde impulsionada por IA que fornece sensores de visão computacional anonimizados e uma plataforma de software para monitorar residentes e pacientes em ambientes de residências para idosos e hospitais. Seu sistema (incluindo o agente de IA Samwise) produz dados ao vivo a nível de sala e análises preditivas para orientar o atendimento de linha de frente, reduzir quedas, melhorar os tempos de resposta, possibilitar faturamento baseado em atividade e oferecer aos líderes insights em nível de portfólio. A Teton enfatiza a privacidade desde a concepção (sem dispositivos vestíveis), integra-se aos fluxos de trabalho existentes e oferece alertas em tempo real, dashboards e exportação de dados. Fundada em 2020, a empresa reporta cerca de 80 funcionários e US$ 26 milhões arrecadados.

Descrição

• Serve as Teton's subject-matter expert on the RAI Manual, MDS 3.0, PDPM, Section GG, Care Area Assessments and Quality Measures • Map platform observations—including mobility, ADLs, sleep, falls, behaviors and staff interactions—to MDS items, look-back periods and PDPM components • Define clinical and reimbursement requirements with product, data science and engineering teams • Write specifications, review models and validate outputs against real assessments • Monitor CMS rule changes, RAI Manual updates, Five-Star and SNF VBP changes, and state Medicaid case-mix methodologies • Convert regulatory and reimbursement changes into product roadmap input • Ensure reimbursement-related insights are defensible, audit-ready and documentation-supported • Build guardrails preventing upcoding and flagging under-capture • Advise on PEPPER, TPE, RAC and survey risk in feature design and positioning • Partner with SNF operators' MDS coordinators, DONs, administrators and regional clinical reimbursement leaders to deploy Teton into workflows • Quantify impact on case-mix index, PDPM rates, Medicaid CMI, quality measures and Five-Star ratings • Build the ROI case for sales and renewals • Represent Teton at industry events and with clients, asset owners and partners • Train commercial, customer success and product teams on SNF reimbursement fundamentals • Develop playbooks, education content and clinical validation protocols as Teton scales across US portfolios

🎯 Requisitos

• 5+ years of direct involvement in national-level MDS and SNF revenue oversight, such as a corporate or multi-region Director/VP of Clinical Reimbursement role at a multi-facility SNF operator • 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, and how regional practices differ • 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) and a commitment to accurate, defensible coding • Active RN license (or LPN/LVN with equivalent senior experience) • RAC-CT, RAC-CTA or equivalent AAPACN certification • Clear communicator who can explain complex reimbursement rules to clinicians, engineers and executives alike

🏖️ Benefícios

• Competitive salary • Equity • Benefits • Opportunity to define how AI supports clinical reimbursement in skilled nursing • Direct influence on product strategy at a fast-growing, venture-backed company • Mission focused on better resident outcomes, reduced caregiver burden, and more predictable operator operations

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