Regional Clinical Reimbursement Leader — MDS/PDPM Expert

Avir Trilogy; El Paso (TX); On-site; USD 90,000 - 130,000; Full time

Job summary

Avir Trilogy is seeking a Clinical Reimbursement Manager to lead reimbursement operations across a regional portfolio of skilled nursing facilities. The role emphasizes accuracy, regulatory compliance, and strong clinical documentation, with a focus on Medicare Part A, PDPM, and Texas Medicaid PDPM-LTC.

The CRM will collaborate with facility leaders and MDS teams, coach staff, and ensure consistent, compliant reimbursement performance while traveling regularly across sites.

Qualifications

• Active RN or LVN/LPN license in good standing.
• 3–5 years of skilled nursing MDS/clinical reimbursement experience.
• Strong knowledge of MDS 3.0 and RAI Manual.
• Understanding of Medicare Part A and PDPM.
• Proven leadership, communication, and organizational skills.
• Willingness to travel extensively across the region.

Responsibilities

• Provide regional reimbursement leadership for an assigned portfolio of SNFs.
• Monitor performance related to Medicare, Medicaid, acuity capture, CMI, and QIPP.
• Develop regional strategies to improve reimbursement while ensuring compliance.
• Collaborate with Administrators, Directors of Nursing, MDS Coordinators, and other partners.
• Maintain facility reimbursement processes with clear expectations and accountability.
• Spend a minimum of three days per week on facility-facing activities.
• Guide MDS 3.0, RAI Manual, PDPM, and CMS/state requirements.
• Monitor MDS completion, accuracy, timeliness, and documentation.
• Identify and address compliance concerns; assist audits and reviews.

Skills

Leadership

Communication

Travel readiness

Regulatory compliance

Education

RN license

LVN/LPN license

Tools

PointClickCare

EHR systems

Job description

Avir Trilogy is seeking a Clinical Reimbursement Manager to lead reimbursement operations across a regional portfolio of skilled nursing facilities. The role emphasizes accuracy, regulatory compliance, and strong clinical documentation, with a focus on Medicare Part A, PDPM, and Texas Medicaid PDPM-LTC.

The CRM will collaborate with facility leaders and MDS teams, coach staff, and ensure consistent, compliant reimbursement performance while traveling regularly across sites.