Director of Clinical Reimbursement, Skilled Nursing

About the role

Location: [Remote US] * Travel: As needed to key clientele (10%)

The role

The Director of Clinical Reimbursement, Skilled Nursing is Teton's senior authority on the RAI process, the MDS 3.0 and PDPM. You will translate deep regional and national reimbursement expertise into Teton's product, so the care our platform observes is accurately reflected in assessments, documentation and revenue.

You will sit at the intersection of clinical operations, product and customers. Your work shapes what we build, how we prove value to SNF operators, and how our clients capture the reimbursement their care already earns, compliantly.

What you'll do

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.

What you bring

• 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.

Nice to have

• 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.

Why Teton

• 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.