Clinical Director of Reimbursement
Overview
Pioneer Health Care Management Inc seeks a Clinical Director of Reimbursement to lead MDS coordination across facilities. This leader will standardize MDS processes ensure regulatory compliance and drive operational excellence.
What You'll Do11
- 1Lead MDS Coordinators and Regional Clinical Teams
- 2Standardize MDS processes across all facilities
- 3Develop and implement corporate MDS policies and procedures
- 4Ensure consistency with CMS regulations and company standards
- 5Assist facilities during leadership transitions and vacancies
- 6Provide on-site support during surveys and regulatory investigations
- 7Serve as corporate expert for MDS PDPM and reimbursement
- 8Oversee assessment scheduling and ARD management
- 9Monitor entry tracking and OBRA assessments
- 10Drive reimbursement accuracy and denial prevention
- 11Collaborate with nursing leadership to enhance clinical documentation
Requirements11
- 15+ years building ETL pipelines with Spark and Airflow
- 23-5 seasons leading healthcare analytics teams
- 3CPC Card certification preferred
- 4AWS Certified cloud expertise required
- 55+ years developing reimbursement policies
- 63-5 years managing CMS compliance programs
- 7BCBA credential valued
- 810-17-23 audit cycle completion
- 910-18-2023 policy development experience
- 10HIPAA compliance demonstrated
- 11State Survey requirements knowledge
Salary Insight
Salary not disclosed in listing
Location
Required Skills
Similar open positions
Explore active roles that match your skills and interests.
Buckner Retirement Services
VerifiedDirector of Clinical Reimbursement
You will lead enterprise reimbursement operations across Buckner Retirement Services skilled nursing communities. Direct PDPM strategies, MDS processes, and revenue integrity. Collaborate with Finance, Therapy, and Central Billing to reduce denials and optimize performance. Drive transformation and standardization, integrating acquisitions and new systems. Mentor teams and build dashboards, shaping financial sustainability and compliance.
Avir at The Renaissance
VerifiedMDS Coordinator Avir at The Renaissance
Manage the RAI Process from resident admission to discharge while maintaining clinical compliance and securing funding from Medicare Medicaid and Managed Care pay sources. Oversee MDS documentation and case mix optimization to ensure proper reimbursement.
American Medical Administrators LTC
VerifiedRegional Nurse Consultant American Medical Administrators LTC
The Regional Nurse Consultant leads clinical strategy for nursing teams at American Medical Administrators LTC. This role drives quality compliance and operational excellence across multiple facilities. You will shape clinical direction while supporting regional leadership.
Gulf Shore Care Center
VerifiedRN MDS Director Skilled Nursing
You will own the entire resident assessment process for a skilled nursing facility in Tampa, FL. You will lead MDS completion, RAI coordination, and reimbursement accuracy across Medicare, Medicaid, and OBRA programs. You will work with the interdisciplinary care team, including rehab, nursing, and administration, to ensure timely and compliant assessments. This role offers the chance to shape QA processes and survey readiness from day one.
Spring Grove Rehabilitation and Healthcare Center
VerifiedMDS Coordinator, RN Long-Term Care
You will own the full MDS assessment lifecycle at a 106-bed sub-acute and long-term care facility, ensuring timely, accurate, and compliant completion of all Minimum Data Set assessments. Working with Marquis Health Consulting Services, you will drive reimbursement accuracy and regulatory compliance, collaborating with interdisciplinary teams to capture resident care needs. Your work directly impacts care planning, Medicare and Medicaid reimbursement, and survey readiness, making you a key player in the facility's clinical and financial success. This role offers a Monday-Friday schedule, daily pay, and competitive compensation between $38 and $60 per hour, within a supportive, values-driven environment.
Lexington Health and Rehabilitation Center
VerifiedMDS Director LPN RN Lexington Healthcare Tampa
We seek an experienced MDS Director LPN RN to lead medical directive services at our facility. The ideal candidate will own MDS processes while delivering high quality patient care across a large interdisciplinary team. This role offers unique opportunities to shape clinical standards and drive operational excellence.