Regional Director of Reimbursement (Regional MDS) Skilled Nursing

Wealthy Group of Companies LLC; Baltimore (MD); Sur place; USD 150 000 - 200 000; Plein temps

Résumé du poste

Wealthy Group of Companies LLC in Baltimore seeks an experienced Regional Director of Reimbursement to lead MDS coordination across our SNFs, guiding PDPM compliance, data integrity, and performance. You will mentor MDS staff, partner with DONs and admins, oversee audits, and drive accuracy in Medicaid/PDPM reimbursement while aligning care plans with resident outcomes.

This role requires an RN with Maryland licensure, RAC-CT preferred, and regional travel to oversee multiple facilities with

Qualifications

• Active RN license in Maryland (or multi-state compact) with SNF MDS experience.
• Thorough mastery of MDS process and PDPM.
• Willingness to travel regionally and lead multiple facilities.
• RAC-CT/C MRT preferred (if applicable).
• Experience with CMS quality reporting and Medicare/Medicaid reimbursement.

Responsabilités

• Provide oversite, training, and mentorship to regional MDS Coordinators across facilities.
• Ensure accurate MDS 3.0 assessments and timely transmissions per regs.
• Drive PDPM-based reimbursement integrity and case-mix accuracy across the network.
• Conduct on-site audits to identify documentation gaps and mitigate compliance risks.
• Collaborate with DONs, Administrators, therapy teams, and leadership to align documentation with care plans.
• Monitor reimbursement analytics, Quality Measures, and Five-Star metrics.
• Standardize billing review processes and resolve ADRs, denials, or appeals.
• Onboard and educate new MDS staff across facilities.

Connaissances

MDS expertise

PDPM knowledge

Regulatory compliance

Leadership

RN licensure

Formation

RN license (Maryland)

Description du poste

We are a premier, mission-driven healthcare organization providing comprehensive skilled nursing and specialized long-term care throughout Maryland. Committed to elevating clinical standards, resident-centered care, and operational integrity, our regional network emphasizes progressive care pathways, interdisciplinary excellence, and rigorous regulatory compliance. We foster a collaborative culture grounded in accountability, operational mentorship, and continuous performance improvement, ensuring our centers serve as pillars of clinical and operational excellence in the communities they support.

Are you an expert MDS Coordinator ready to take the next defining step in your career? The Regional Director of Reimbursement is a high-impact, career-elevating opportunity designed for a knowledgeable reimbursement specialist or an accomplished, building-level MDS professional who has mastered the RAI process and is eager to step up into multi-facility leadership. If you find yourself consistently answering questions for your peers, auditing with an eye for detail, and wanting to influence clinical reimbursement and care planning on a broader, strategic scale, this role provides the ideal platform, executive backing, and regional runway to expand your leadership footprint.

Serving as the chief clinical reimbursement authority across our network of skilled nursing facilities in the Baltimore area, you will transition from managing day-to-day data entry into guiding, mentoring, and empowering building-level MDS teams. Working closely with executive operations, Directors of Nursing, and facility administrators, you will champion clinical documentation integrity, drive reimbursement accuracy under PDPM and Medicaid case mix, and establish regional best practices. This role blends strategic oversight with hands-on, field-based collaboration across our Baltimore-area centers, making it the perfect launchpad for a driven MDS professional ready to make a regional name for themselves.

Key Responsibilities

• Provide direct functional oversight, training, and mentorship to facility MDS Coordinators across the regional skilled nursing portfolio.
• Oversee the accuracy, scheduling, and timely transmission of all Minimum Data Set (MDS 3.0) assessments in accordance with state and federal regulations.
• Drive clinical reimbursement integrity under the Patient-Driven Payment Model (PDPM) and Maryland Medicaid case-mix reimbursement structures.
• Conduct regular on-site clinical record audits to identify documentation gaps, ensure capture of resident acuity, and mitigate compliance risks.
• Partner closely with facility Directors of Nursing (DONs), Administrators (LNHAs), therapy teams, and regional leadership to align clinical documentation with resident care plans.
• Monitor key reimbursement analytics, Quality Measures (QMs), and Five-Star data points driven by MDS submissions.
• Standardize triple-check billing review processes and resolve any MDS-related ADRs (Additional Documentation Requests), denials, or audit appeals.
• Onboard, train, and provide ongoing education to new building-level MDS personnel, stepping in to support assessment workflows during staffing transitions if needed.

Qualifications & Requirements

• Licensure: Active Registered Nurse (RN) license in Maryland (or multi-state compact license); exceptional Licensed Practical Nurses (LPNs) with extensive, advanced MDS track records will also be considered.
• Experience: Thorough, hands-on mastery of the MDS process strictly within the Skilled Nursing Facility (SNF) sector.
• Career Level: Open to experienced Regional MDS / Reimbursement Directors, as well as accomplished, building-level MDS Coordinators with strong leadership aptitude who are ready to step up into a regional role.
• Technical Expertise: Deep knowledge of MDS 3.0, RAI guidelines, PDPM, Maryland Medicaid Case Mix, CMS quality reporting, and skilled nursing billing compliance.
• Certifications: RAC-CT (Resident Assessment Coordinator-Certified) or RAC-CTA preferred.
• Mobility: Ability to travel locally and maintain an active on-site presence across the facilities in the Baltimore metropolitan area.

Compensation

• Base Salary: $150,000 - $200,000 (commensurate with experience and background).