teton - Director of Clinical Reimbursement, Skilled Nursing
Requirements
• 5+ years of direct involvement in national-level MDS and SNF revenue oversight, such as 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 how regional practices differ. • Track record of improving MDS accuracy, case-mix capture and reimbursement outcomes across a portfolio of facilities. • Strong grasp of compliance and audit risk (PEPPER, TPE, RAC, survey) and a commitment to accurate, defensible coding. • Active RN license (or LPN/LVN with equivalent senior experience). • RAC-CT, RAC-CTA or equivalent AAPACN certification. • Clear communicator who can explain complex reimbursement rules to clinicians, engineers and executives alike. • Experience translating clinical knowledge into technology: working with product or engineering teams, defining requirements, or validating software, analytics or AI outputs. • Client-facing experience in a consulting, health tech, EHR or software vendor role serving SNF operators. • Familiarity with SNF EHRs (e.g., PointClickCare, MatrixCare) and MDS data analytics. • Experience presenting to operator executives, REITs or other senior housing asset owners. • Exposure to SNF quality programs (Five-Star, SNF QRP, SNF VBP) and their link to reimbursement.
Responsibilities
• Translate RAI and MDS expertise into product • Serve as Teton's subject-matter expert on the RAI Manual, MDS 3.0, PDPM, Section GG, Care Area Assessments and Quality Measures. • Map what Teton's platform observes (mobility, ADLs, sleep, falls, behaviors, staff interactions) to MDS items, look-back periods and PDPM components. • Define clinical and reimbursement requirements with product, data science and engineering; write specs, review models and validate outputs against real assessments. • Monitor CMS rule changes, RAI Manual updates, Five-Star and SNF VBP changes, and state Medicaid case-mix methodologies, and turn them into product roadmap input. • Protect accuracy and compliance • Ensure every reimbursement-related insight Teton delivers is defensible, audit-ready and supported by documentation. • Build guardrails that prevent upcoding and flag under-capture, so clients capture accurate reimbursement, not inflated reimbursement. • Advise on PEPPER, TPE, RAC and survey risk in how features are designed and positioned. • Drive client outcomes • Partner with SNF operators' MDS coordinators, DONs, administrators and regional clinical reimbursement leaders to deploy Teton into their workflows. • Quantify impact on case-mix index, PDPM rates, Medicaid CMI, quality measures and Five-Star ratings; build the ROI case for sales and renewals. • Represent Teton at industry events and with clients, asset owners and partners as a credible clinical reimbursement voice. • Build internal capability • Train Teton's commercial, customer success and product teams on SNF reimbursement fundamentals. • Develop playbooks, education content and clinical validation protocols as we scale across US portfolios.
Benefits
• Define how AI supports clinical reimbursement in skilled nursing, as the first senior leader in this function. • Direct influence on product strategy at a fast-growing, venture-backed company. • A mission that matters: better outcomes for residents, less burden for caregivers, more predictable operations for operators. • Competitive salary, equity and benefits.
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