Director of Clinical Documentation & Reimbursement (MDS)

Pride Health; New York (NY); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Health insurance

Retirement plans

PTO

Professional development

Job summary

Pride Health is seeking a Director of Clinical Documentation & Reimbursement to lead MDS and HIM teams in Bronx, NY. This position requires operational and strategic leadership, ensuring compliance with regulations while optimizing reimbursement through accurate clinical documentation.

The ideal candidate will have a BSN, active NY RN license, and a minimum of 3 years’ experience in reimbursement and RAI processes. A comprehensive benefits package includes health insurance and retirement plans.

Qualifications

• Minimum 3 years of SNF reimbursement and RAI process experience.
• Strong knowledge of Medicare, Medicaid, and NYS nursing regulations.
• Experience with data extraction, analysis, and quality metrics.

Responsibilities

• Lead and oversee MDS and HIM teams.
• Ensure compliance with RAI process and NYS DOH standards.
• Drive Medicare/Medicaid and Managed Care reimbursement strategy.
• Analyze MDS data to support Quality Assurance & Performance Improvement.
• Develop and implement facility-wide education on MDS updates.

Skills

Leadership

Regulatory compliance

Clinical documentation

Data analysis

Communication skills

Education

BSN required; MSN preferred

Active NY RN license required

Job description

Director of Clinical Documentation & Reimbursement (MDS) – Full Time

Location: Bronx, NY

Job Type: FTE/Permanent

A leading senior care campus in the Bronx is seeking an experienced Director of Clinical Documentation & Reimbursement to lead the MDS and HIM departments. This leadership role is responsible for overseeing the RAI process, ensuring regulatory compliance, and driving reimbursement accuracy through strong clinical documentation and data analysis.

Position Overview

This role provides operational and strategic leadership for Clinical Documentation (MDS) and Health Information Management (HIM). The Director will ensure compliance with all federal and NYS regulations related to the RAI process while optimizing Medicare, Medicaid, and Managed Care reimbursement through accurate documentation, education, and quality monitoring.

Key Responsibilities

• Lead and oversee MDS and HIM teams
• Ensure full compliance with RAI process and NYS DOH standards
• Drive Medicare/Medicaid and Managed Care reimbursement strategy
• Analyze MDS data to support Quality Assurance & Performance Improvement (QAPI)
• Develop and implement facility-wide education on MDS updates, payment reforms, and quality measures
• Audit documentation practices to ensure accuracy and regulatory adherence
• Collaborate with department leaders to enhance quality of care through clinical data insights

Qualifications

• BSN required; MSN preferred
• Active NY RN license required
• Minimum 3 years of SNF reimbursement and RAI process experience
• PRI Assessor certification preferred; RAC-CT preferred
• Strong knowledge of Medicare, Medicaid, and NYS nursing regulations
• Experience with data extraction, analysis, and quality metrics (QM, QRP, VBP)
• Proven leadership, analytical, and project management skills
• Excellent communication and team leadership abilities
• Comprehensive benefits package including health insurance, retirement plans, PTO, and professional development