Regional Clinical Reimbursement Consultant - State Veterans Homes

Regional Clinical Reimbursement Consultant – State Veterans Homes

The Regional Clinical Reimbursement Consultant (RCRC) provides leadership and oversight of clinical reimbursement processes across multiple long‑term care facilities within an assigned region. This role ensures accurate and compliant MDS completion, optimized reimbursement under PDPM, regulatory compliance, and consistent application of best practices while partnering with clinical, financial, and operational leaders to drive outcomes. Travel is required and extensive throughout the assigned region.

• Oversee clinical reimbursement operations across multiple skilled nursing facilities.
• Ensure accurate, timely, and compliant completion of MDS assessments in accordance with CMS requirements.
• Monitor PDPM performance, case‑mix accuracy, and reimbursement trends.
• Identify opportunities to optimize reimbursement while maintaining clinical integrity and compliance.

• Provide guidance and oversight to MDS coordinators and facility leadership.
• Ensure interdisciplinary documentation supports clinical conditions, diagnoses, and care needs.
• Support MDS scheduling, care area assessments (CAAs), and care planning processes.

• Ensure compliance with federal and state regulations, RAI Manual, and payer requirements.
• Support internal and external audits, including medical record reviews and ADRs.
• Lead corrective action plans related to MDS, documentation, and reimbursement findings.

• Develop and deliver ongoing education related to PDPM, MDS, ICD‑10 coding, and documentation standards.
• Support onboarding and competency development of MDS and clinical reimbursement staff.
• Stay current on CMS updates, rule changes, and industry best practices.

• Review and analyze reimbursement and quality data, including PDPM components, case‑mix indices, and revenue impacts.
• Provide regular reporting and recommendations to regional and corporate leadership.
• Partner with business office and clinical teams to resolve billing, denials, and reimbursement issues.

• Work closely with Regional Clinical, Operations, and Finance leadership.
• Serve as a regional resource for reimbursement‑related questions and problem resolution.
• Promote a culture of compliance, accuracy, and continuous improvement.

• Active Registered Nurse (RN) license in good standing.
• Bachelor’s degree in Nursing (BSN required).
• Minimum 5–7 years of MDS and clinical reimbursement experience in long‑term care.
• Strong knowledge of PDPM, RAI Manual, ICD‑10 coding, and CMS regulations.
• Experience supporting audits and survey processes.
• Ability to travel regularly within the assigned region.

• Prior regional or multi‑facility reimbursement leadership experience.
• RAC‑CT, DNS‑CT, or similar certification.
• Master’s degree in Nursing, Healthcare Administration, or related field.

• Strong analytical and financial acumen.
• Excellent attention to detail and regulatory knowledge.
• Effective leadership, coaching, and education skills.
• Clear written and verbal communication.
• Ability to manage multiple facilities and priorities.

The physical demands and work environment described herein are representative of those that generally must be met by a team member to successfully perform the essential functions of this job: sitting, standing, walking, twisting, reaching, bending/stooping, pushing and pulling (typical weight of 5 lbs. and maximum weight of 100 lbs., approximately) and lifting (minimum weight of 5 lbs. and maximum weight of 100 lbs.,

approximately). The position requires repetitive finger movements as well as hearing and talking on the phone and in person. Must be able to continuously deal effectively with stress created by residents, multiple tasks, noises, interruptions, and work cooperatively as part of the health care team while maintaining a pleasant attitude.

STGi offers a competitive benefits package which includes Medical, Dental, Vision, 401k with company match and a generous PTO policy.

STGi is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class.