Director of Clinical Reimbursement – Skilled Nursing

Job not on LinkedIn

🔥 16 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

👔 Director

👻 Ghost score 16%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Teton

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

🤖 Artificial Intelligence

🔧 Hardware

💰 $20M Series A - Teton on 2025-09

Healthcare • Artificial Intelligence • Hardware

Teton is an AI-driven healthcare technology company that provides anonymized computer-vision sensors and a software platform to monitor residents and patients in senior living and hospital settings. Its system (including the Samwise AI agent) produces live, room-level data and predictive analytics to guide frontline care, reduce falls, improve response times, enable activity-based billing, and give leaders portfolio-level insights. Teton emphasizes privacy-by-design (no wearables), integrates into existing workflows, and offers real-time alerts, dashboards, and exportable data. Founded in 2020, the company reports ~80 employees and $26M raised.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume