Regional Director, Case Management & Reimbursement

Marquis Health Consulting Services; Woburn (MA); On-site; USD 115,000 - 190,000; Full time

Benefits offered by this job

Tuition reimbursement

Health, vision, and dental benefits

401(k) with company match

Employee engagement program

Life insurance

EAP resources

Employee referral bonus

Job summary

Marquis Health Consulting Services is seeking a Regional Director of Case Management and Clinical Reimbursement to oversee case management, MDS, and reimbursement across multiple SNFs. You’ll align clinical care with regulatory requirements while driving financial performance and high-quality resident outcomes.

The ideal candidate is an RN with 3+ years in SNF reimbursement leadership, strong Medicare/Medicaid knowledge, and willingness to travel regionally to support facilities.

Qualifications

• Must be a Registered Nurse with an active and unrestricted license.
• Minimum of 3+ years of leadership experience in skilled nursing clinical reimbursement, MDS, or case management.
• Expert knowledge of Medicare Parts A, B, C, and D; State Medicaid systems; Managed Care; and other reimbursement methodologies.
• Extensive knowledge of the Long-Term Care MDS/RAI process; AANAC certification preferred.
• Demonstrated success in developing and implementing systems that improve SNF clinical reimbursement compliance and performance.
• Strong understanding of skilled nursing regulations, clinical operations, and quality measures.
• Exceptional leadership, communication, organizational, and problem-solving skills.
• Ability to travel throughout the assigned region as business needs require.

Responsibilities

• Provide regional oversight and leadership for case management, MDS, and clinical reimbursement processes across assigned facilities.
• Ensure compliance with Medicare, Medicaid, Managed Care, and other payer requirements while maximizing appropriate reimbursement opportunities.
• Mentor and support MDS Coordinators, Case Managers, and interdisciplinary teams in best practices for clinical documentation, reimbursement, and regulatory compliance.
• Monitor reimbursement performance, quality measures, and key clinical metrics to identify trends and implement process improvements.
• Conduct routine audits of MDS assessments, care plans, clinical documentation, and reimbursement systems to ensure accuracy and compliance.
• Collaborate with facility leadership to develop action plans that improve reimbursement outcomes while maintaining exceptional clinical care.
• Provide education and training on Medicare regulations, PDPM, RAI/MDS processes, and payer-specific requirements.
• Assist facilities during regulatory surveys, reimbursement audits, and compliance reviews.
• Partner with operations, finance, and clinical leadership to support strategic initiatives that enhance both resident outcomes and financial performance.

Skills

RN License

Leadership

Regulatory knowledge

Job description

Marquis Health Consulting Services is seeking a Regional Director of Case Management and Clinical Reimbursement to oversee case management, MDS, and reimbursement across multiple SNFs. You’ll align clinical care with regulatory requirements while driving financial performance and high-quality resident outcomes.

The ideal candidate is an RN with 3+ years in SNF reimbursement leadership, strong Medicare/Medicaid knowledge, and willingness to travel regionally to support facilities.