Director of Clinical Reimbursement, Skilled Nursing

Teton.ai

2d•Remote

About The Position

Teton is hiring a senior clinical reimbursement leader for skilled nursing to serve as its authority on the RAI process, MDS 3.0 and PDPM. The role translates regional and national reimbursement expertise into Teton’s AI and computer vision product, ensuring that observed care is accurately reflected in assessments, documentation and reimbursement. The position works across clinical operations, product and customers, influencing product development, demonstrating value to skilled nursing facility (SNF) operators, and helping clients capture accurate reimbursement compliantly. The Director maps platform observations—including mobility, ADLs, sleep, falls, behaviors and staff interactions—to MDS items, look-back periods and PDPM components. They define requirements with product, data science and engineering teams; validate outputs against real assessments; and monitor regulatory and reimbursement changes. The role also safeguards the accuracy and auditability of reimbursement-related insights, supports client implementation and outcomes, and builds reimbursement knowledge and validation capability across Teton’s teams.

Requirements

At least 5 years of direct involvement in national-level MDS and SNF revenue oversight, such as in a corporate or multi-region Director/VP of Clinical Reimbursement role at a multi-facility SNF operator.
Expert, current knowledge of the RAI Manual, MDS 3.0, PDPM, Section GG, and Medicare Part A and Medicaid case-mix reimbursement.
Working knowledge of state Medicaid case-mix systems across multiple states and regional practice differences.
A track record of improving MDS accuracy, case-mix capture and reimbursement outcomes across a portfolio of facilities.
Strong understanding of compliance and audit risk, including PEPPER, TPE, RAC and survey risk, and commitment to accurate, defensible coding.
Active RN license, or LPN/LVN license with equivalent senior experience.
RAC-CT, RAC-CTA or equivalent AAPACN certification.
Ability to explain complex reimbursement rules clearly to clinicians, engineers and executives.

Nice To Haves

Experience translating clinical knowledge into technology, including working with product or engineering teams, defining requirements, or validating software, analytics or AI outputs.
Client-facing experience in consulting, health tech, an EHR company or a software vendor serving SNF operators.
Familiarity with SNF EHRs such as PointClickCare or MatrixCare, and MDS data analytics.
Experience presenting to operator executives, REITs or other senior housing asset owners.
Exposure to SNF quality programs, including Five-Star, SNF QRP and SNF VBP, and their relationship to reimbursement.

Responsibilities

Serve as Teton’s subject-matter expert on the RAI Manual, MDS 3.0, PDPM, Section GG, Care Area Assessments and Quality Measures.
Map platform observations to MDS items, look-back periods and PDPM components.
Define clinical and reimbursement requirements with product, data science and engineering teams; write specifications, review models and validate outputs against real assessments.
Monitor CMS rules, RAI Manual updates, Five-Star and SNF VBP changes, and state Medicaid case-mix methodologies, and translate changes into product roadmap input.
Ensure reimbursement-related insights are defensible, audit-ready and supported by documentation.
Build guardrails to prevent upcoding and flag under-capture so clients receive accurate rather than inflated reimbursement.
Advise on PEPPER, TPE, RAC and survey risk in feature design and positioning.
Partner with SNF operators’ MDS coordinators, DONs, administrators and regional clinical reimbursement leaders to deploy Teton in their workflows.
Quantify impact on case-mix index, PDPM rates, Medicaid CMI, quality measures and Five-Star ratings, and build ROI cases for sales and renewals.
Represent Teton at industry events and with clients, asset owners and partners as a clinical reimbursement expert.
Train commercial, customer success and product teams on SNF reimbursement fundamentals.
Develop playbooks, educational content and clinical validation protocols as Teton scales across US portfolios.