Teton Director of Clinical Reimbursement, Skilled Nursing at Teton to lead expertise on RAI process, MDS 3.0, and PDPM. Translate clinical reimbursement knowledge into product features and ensure compliance and accuracy.
Responsibilities
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.
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.
Qualification
Familiarity with SNF EHRs (eA mission that matters
Preferred
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.
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.
