Remote Director, Clinical Reimbursement - Skilled Nursing

Teton; United States; Remote; USD 180,000 - 280,000; Full time

Job summary

Teton.ai seeks a Director of Clinical Reimbursement for Skilled Nursing to lead reimbursement strategy across RAI, MDS 3.0 and PDPM. You will align clinical operations, product and customers to ensure compliant, accurate reimbursement and impactful product improvements.

This senior role influences the roadmap, partners with SNF operators, and drives improvements in case-mix, Five-Star outcomes and ROI. Remote US with travel as needed to key clientele (10%).

Qualifications

• 5+ years in national-level MDS/SNF revenue oversight (Director/VP level).
• Expert knowledge of the RAI Manual, MDS 3.0, PDPM, Section GG, Medicare Part A and Medicaid case-mix.
• Knowledge of state Medicaid case-mix across multiple states and regional practices.
• Track record of improving MDS accuracy, case-mix capture and reimbursement outcomes.
• Strong focus on compliance, audit risk (PEPPER, TPE, RAC, survey).

Responsibilities

• Translate RAI and MDS expertise into product requirements and roadmap inputs.
• Define clinical and reimbursement requirements with product, data science and engineering; write specs and validate outputs.
• Monitor CMS rule changes, RAI Manual updates, Five-Star and SNF VBP changes; translate into roadmap input.
• Build guardrails and audit trails to ensure defensible reimbursements and prevent upcoding.
• Train teams on SNF reimbursement fundamentals and develop validation protocols.

Skills

MDS knowledge

PDPM understanding

Regulatory compliance

Clear communication

Cross-functional collaboration

Education

RN license

RAC-CT / RAC-CTA or AAPACN certification

Job description

Teton.ai seeks a Director of Clinical Reimbursement for Skilled Nursing to lead reimbursement strategy across RAI, MDS 3.0 and PDPM. You will align clinical operations, product and customers to ensure compliant, accurate reimbursement and impactful product improvements.

This senior role influences the roadmap, partners with SNF operators, and drives improvements in case-mix, Five-Star outcomes and ROI. Remote US with travel as needed to key clientele (10%).