Regional Director: Case Management & Reimbursement Excellence

Apploi; Woburn (MA); On-site; USD 115,000 - 190,000; Full time

Benefits offered by this job

Tuition reimbursement

Employee referral bonus

Health, vision, and dental benefits

401(k) with company match

Employee Engagement and Culture Commit

Company-sponsored life insurance

Employee Assistance Program (EAP)

Job summary

Marquis Health Consulting Services seeks a Regional Director of Case Management and Clinical Reimbursement to lead regional oversight of case management, MDS, and clinical reimbursement across multiple skilled nursing facilities.

The ideal candidate is an RN with 3+ years of leadership experience in SNF reimbursement, with expert knowledge of Medicare and Medicaid programs and PDPM, and a track record of improving reimbursement performance while maintaining high-quality resident care.

Qualifications

• Must be a Registered Nurse (RN) 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.

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

Leadership

Clinical knowledge

Regulatory compliance

Communication

Problem solving

Travel flexibility

Education

RN license

AANAC certification (preferred)

Job description

Marquis Health Consulting Services seeks a Regional Director of Case Management and Clinical Reimbursement to lead regional oversight of case management, MDS, and clinical reimbursement across multiple skilled nursing facilities.

The ideal candidate is an RN with 3+ years of leadership experience in SNF reimbursement, with expert knowledge of Medicare and Medicaid programs and PDPM, and a track record of improving reimbursement performance while maintaining high-quality resident care.