Regional Clinical Reimbursement Specialist

Volare Health, LLC; Eugene (OR); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Advancement opportunities

Health coverage

Company-paid life insurance

HSA/FSA options

PTO & paid holidays

Tuition reimbursement

Job summary

Volare Health, LLC is seeking an experienced Clinical Reimbursement Specialist to support our Northern Oregon facilities. The role requires strong MDS/RAI knowledge, a current RN license, and a proven ability to lead across multiple sites with travel as needed.

You will supervise MDS Coordinators, optimize reimbursement through accurate assessments, and collaborate with interdisciplinary teams to ensure CMS Five-Star ratings and quality measures are upheld across facilities.

Qualifications

• Experience with MDS/RAI processes and CMS Five-Star responsibilities.
• Active RN license in Oregon or a compact state.
• Background in multi-facility support and reimbursement optimization.

Responsibilities

• Act as a clinical resource for MDS Coordinators across Northern Oregon facilities.
• Monitor Medicare/Medicaid data accuracy to maximize reimbursement.
• Support accurate and timely claims and billing processes.
• Educate IDT members on CMS Five-Star Ratings and Quality Measures.
• Lead audits for new systems, policies, and training programs.
• Participate in QAPI data analysis and action planning.
• Assist in preparation for state and federal surveys and mock surveys.

Skills

MDS/RAI expertise

RN license (Oregon/compact)

Multisite support

CMS Five-Star/Quality Measures

MS Office

Education

Associate or Bachelor’s degree in Nursing

Tools

MS Office Suite

Job description

Location: Northern Oregon (Travel Required Across Regional Facilities)
Schedule: Full-Time

About The Role

We are currently seeking an experienced and dedicated Clinical Reimbursement Specialist to support our skilled nursing facilities across Northern Oregon. This position provides leadership, training, and oversight to MDS Coordinators and interdisciplinary teams to ensure compliance with the RAI process and maximize reimbursement through accurate assessments.
This is a high-impact role ideal for a knowledgeable RN with a strong background in MDS and multi-site clinical support.

Key Responsibilities

• Act as a clinical resource for MDS Coordinators throughout our Northern Oregon facilities.
• Monitor Medicare and Medicaid data for accuracy and reimbursement optimization.
• Support accurate and timely claims and billing processes.
• Collaborate with Regional Nurse Consultants and IDT members to educate and strengthen systems related to CMS Five-Star Ratings and Quality Measures.
• Lead implementation and follow-up audits for new systems, policies, and training programs.
• Participate in QAPI efforts including data analysis, root cause evaluations, and measurable action planning.
• Assist in preparation for state and federal surveys and participate in internal “mock survey” processes.

Qualifications

• Current and active Registered Nurse (RN) license in Oregon or compact state.
• Associate or Bachelor’s degree in Nursing from an accredited institution.
• 3+ years of MDS/RAI experience required.
• Previous experience supporting multiple facilities preferred.
• In-depth knowledge of PDPM and Oregon’s reimbursement system.
• Familiarity with long-term care regulations and standards.
• Excellent verbal, written, and interpersonal communication skills.
• Ability to travel throughout Northern Oregon, sometimes on short notice.
• Highly organized, self-motivated, and detail-oriented.
• Proficient in Microsoft Office (Excel, Word, PowerPoint).

Benefits And Perks

• Opportunities for advancement within a respected and growing healthcare organization.
• Competitive health, dental, and vision coverage for you and your family.
• Company-paid life insurance.
• Health Savings Account (HSA) and Flexible Spending Account (FSA) options.
• Paid Time Off (PTO) and paid holidays.
• Tuition reimbursement to support continued professional growth.

Make a Difference Across Northern Oregon

Join our team and play a vital role in driving quality and compliance in post-acute care. Your clinical insight and leadership will directly impact resident care and organizational success across the Northern Oregon region.