Regional MDS & PDPM Reimbursement Lead

Avir Trilogy; Houston (TX); On-site; USD 110,000 - 140,000; Full time

Job summary

Avir Trilogy is seeking a Clinical Reimbursement Manager to provide regional leadership for clinical reimbursement operations across an assigned portfolio of skilled nursing facilities. You will lead MDS/RAI compliance, PDPM implementation, and Medicare/Medicaid strategies, with regular on-site visits and extensive travel.

This role requires RN licensure, strong leadership, and the ability to educate staff while improving accuracy, compliance, and financial performance.

Qualifications

• Current 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.
• Knowledge of Medicare Part A and PDPM.
• Strong clinical documentation and reimbursement compliance.
• Proven leadership, communication, and organizational skills.
• Willingness to travel extensively in the assigned region.
• Preferred RN licensure; RAC-CT or equivalent certification.
• Experience with Texas Medicaid PDPM-LTC and QIPP.
• Experience with PointClickCare or similar EHR systems.

Responsibilities

• Provide regional reimbursement leadership for an assigned portfolio of facilities.
• Monitor performance on Medicare/Medicaid, acuity capture, CMI, and QIPP.
• Develop regional strategies to improve reimbursement while ensuring compliance.
• Partner with Administrators, Directors of Nursing, MDS Coordinators, and others.
• Maintain regular facility presence and conduct visits as needed.
• Guide MDS/RAI compliance and assess coding accuracy.
• Identify compliance concerns and implement corrective actions.
• Support facilities during audits and reviews.
• Analyze reimbursement metrics and drive improvement.
• Educate and mentor MDS personnel and reimbursement staff.
• Lead recruitment and development of reimbursement resources.

Skills

RN license

Leadership

Clinical documentation

PDPM

MDS 3.0

Regulatory compliance

Travel readiness

Communication

Education

RN licensure

RAC-CT certification

Tools

PointClickCare

Job description

Avir Trilogy is seeking a Clinical Reimbursement Manager to provide regional leadership for clinical reimbursement operations across an assigned portfolio of skilled nursing facilities. You will lead MDS/RAI compliance, PDPM implementation, and Medicare/Medicaid strategies, with regular on-site visits and extensive travel.

This role requires RN licensure, strong leadership, and the ability to educate staff while improving accuracy, compliance, and financial performance.