SVP of Clinical Reimbursement

Volare Health, LLC•Louisville, KY

9d•Onsite

About The Position

We are seeking a strategic, results-driven Senior Vice President of Clinical Reimbursement (RN) to lead and optimize reimbursement operations across our organization. This executive role partners closely with clinical and operational leaders to ensure accurate reimbursement, regulatory compliance, and top-tier quality outcomes. You’ll serve as the go-to expert in RAI, PDPM, and Case Mix, driving education, performance improvement, and financial integrity across multiple skilled nursing facilities.

Requirements

Active Registered Nurse (RN) license
Associate or bachelor’s degree in nursing
3+ years of hands-on experience with the RAI process
Strong expertise in the PDPM reimbursement model
Strong expertise in State Case Mix systems
Deep understanding of long-term care regulations and compliance
Microsoft Office (Excel, Word, PowerPoint)

Nice To Haves

Multi-facility or regional experience
Experience improving CMS Five-Star ratings
Data analysis and reporting tools

Responsibilities

Serve as the clinical reimbursement authority across all facilities
Guide MDS Coordinators and regional teams on RAI, PDPM, and Case Mix
Monitor Medicare and Case Mix performance metrics
Identify trends and implement strategies to maximize reimbursement
Partner with Regional Nurse Consultants to improve Quality Measures (QM) and CMS Five-Star Ratings
Support interdisciplinary teams (IDT) with education and systems development
Oversee RAI process compliance with federal and state regulations
Support accurate coding, billing, and claims submission
Drive QAPI efforts including trend analysis, root cause analysis, solution implementation and tracking
Participate in mock surveys and regulatory preparation
Ensure facilities are always audit-ready