Regional Director of Case Management and Clinical Reimbursement

Responsibilities

• Provide regional oversight and leadership for case management, MDS, and clinical reimbursement processes across assigned facilities.
• Ensure compliance with Medicare, Medicaid, Managed Care, and other payer requirements while maximizing appropriate reimbursement opportunities.
• Mentor and support MDS Coordinators, Case Managers, and interdisciplinary teams in best practices for clinical documentation, reimbursement, and regulatory compliance.
• Monitor reimbursement performance, quality measures, and key clinical metrics to identify trends and implement process improvements.
• Conduct routine audits of MDS assessments, care plans, clinical documentation, and reimbursement systems to ensure accuracy and compliance.
• Collaborate with facility leadership to develop action plans that improve reimbursement outcomes while maintaining exceptional clinical care.
• Provide education and training on Medicare regulations, PDPM, RAI/MDS processes, and payer-specific requirements.
• Assist facilities during regulatory surveys, reimbursement audits, and compliance reviews.
• Partner with operations, finance, and clinical leadership to support strategic initiatives that enhance both resident outcomes and financial performance.

Qualifications

• Must be a Registered Nurse (RN) with an active and unrestricted license.
• Minimum of 3+ years of leadership experience in skilled nursing clinical reimbursement, MDS, or case management required.
• Expert knowledge of Medicare Parts A, B, C, and D; State Medicaid systems; Managed Care; and other reimbursement methodologies.
• Extensive knowledge of the Long-Term Care MDS/RAI process; AANAC certification preferred.
• Demonstrated success in developing and implementing systems that improve SNF clinical reimbursement compliance and performance.
• Strong understanding of skilled nursing regulations, clinical operations, and quality measures.
• Exceptional leadership, communication, organizational, and problem-solving skills.
• Ability to travel throughout the assigned region as business needs require.

Benefits

• Tuition reimbursement
• Employee referral bonus
• Health, vision, and dental benefits
• 401(k) with company match
• Employee engagement and culture committee
• Company-sponsored life insurance
• Employee Assistance Program (EAP) resources