MDS Director and Reimbursement Manager

Description

Cascadia Healthcare is seeking an experienced and strategic Director of MDS & Reimbursement to lead resident assessment, clinical documentation integrity, reimbursement programs, and MDS operations across multiple skilled nursing facilities.

This leader serves as the organization's subject matter expert for MDS, PDPM, Medicare and Medicaid reimbursement, case mix methodologies, audit readiness, and regulatory compliance. The Director partners closely with clinical, operations, finance, therapy, compliance, and facility leaders to ensure accurate resident assessments, compliant reimbursement practices, and excellence in clinical documentation.

This is an exciting opportunity to influence enterprise-wide clinical and reimbursement strategy while supporting resident-centered care throughout the organization.

Duties & Responsibilities

MDS and Resident Assessment Leadership 

• Set and maintain organization-wide standards for timely, accurate, and complete MDS assessments in accordance with the RAI Manual, CMS requirements, state-specific rules, and company policy. 
• Provide oversight of assessment scheduling, interdisciplinary participation, coding practices, completion, submission, validation, corrections, and supporting documentation. 
• Ensure the MDS accurately represents the resident's clinical condition, functional status, goals, risks, services, and plan of care. 
• Monitor facility processes for admission, quarterly, annual, significant change, significant correction, discharge, and payer-specific assessments. 
• Guide leaders through complex coding, assessment, and care-planning questions and elevate systemic risks requiring organizational action. 

Reimbursement Strategy and Integrity 

• Lead reimbursement strategy across Medicare, Medicaid, managed care, and other applicable payment models, with particular expertise in PDPM and state case-mix methodologies. 
• Translate regulatory and payment-model changes into clear operational guidance, workflows, education, and monitoring tools. 
• Partner with facility and regional teams to identify documentation or process gaps that may result in inaccurate payment, avoidable denials, or compliance exposure. 
• Promote capture of all clinically supported reimbursement opportunities without encouraging unsupported coding, unnecessary services, or practices driven solely by financial outcomes. 
• Collaborate with finance and operations to evaluate reimbursement trends, forecast impacts, and explain performance variance while preserving clinical and regulatory integrity. 

Clinical Documentation and Interdisciplinary Alignment 

• Align nursing, provider, therapy, dietary, social services, and other interdisciplinary documentation with the resident's assessed needs and delivered services. 
• Partner with clinical and therapy leaders to strengthen documentation of diagnoses, skilled need, function, mood, cognition, swallowing, restorative nursing, nursing services, and other reimbursement-sensitive clinical areas. 
• Ensure assessment findings support individualized care planning and are consistent across the medical record, claims, quality reporting, and survey evidence. 
• Develop practical tools and workflows that reduce silos between clinical decision-making, MDS completion, billing, and reimbursement review. 

Compliance Audit and Risk Management 

• Design and oversee a risk-based audit program for MDS accuracy, assessment timeliness, clinical support, reimbursement accuracy, and corrective action follow-through. 
• Monitor CMS, state agency, MAC, managed care, and other payer guidance; prepare the organization for audits, reviews, and regulatory changes. 
• Support responses to ADRs, denials, validation reviews, payment audits, and other reimbursement inquiries in partnership with compliance, clinical, billing, legal, and facility teams. 
• Identify trends, determine root causes, and ensure corrective actions are measurable, sustainable, and communicated to the appropriate leaders. 
• Escalate suspected overpayments, unsupported claims, systemic documentation concerns, or compliance issues promptly through established reporting channels. 

Education and Field Support 

• Develop and deliver onboarding, continuing education, competency validation, and role-specific training for MDS coordinators and interdisciplinary leaders. 
• Coach facility and regional teams through performance improvement with clear expectations, practical resources, and timely follow-up. 
• Build a consistent support model that gives facility teams ready access to knowledgeable guidance while strengthening local ownership and accountability. 
• Facilitate communities of practice, case reviews, and targeted education based on audit findings, regulatory updates, and performance trends. 

Program Leadership and Collaboration 

• Establish the strategic direction, annual priorities, policies, procedures, and standard work for the MDS and reimbursement program. 
• Lead, develop, and evaluate assigned MDS and reimbursement resources; clarify roles, coverage, escalation pathways, and performance expectations. 
• Partner closely with Chief Nursing Officers, Chief Executive Officers, regional leaders, therapy, finance, revenue cycle, compliance, information technology, and other departments. 
• Support new acquisitions, system conversions, program implementation, and operational transitions through readiness assessments, education, and focused follow-up. 
• Evaluate technology and reporting tools that improve assessment accuracy, visibility, efficiency, and decision-making. 

Requirements

• Current Registered Nurse (RN) license in good standing.

• Bachelor's degree in nursing, Healthcare Administration, Business, Finance, or a related field; equivalent experience may be considered.

• Five or more years of progressive skilled nursing experience with substantial responsibility for MDS, reimbursement, clinical documentation, or related functions.

• Advanced knowledge of the Resident Assessment Instrument (RAI) process and MDS requirements.

• Strong understanding of PDPM, Medicare reimbursement, Medicaid reimbursement, and skilled nursing facility operations.

• Experience interpreting healthcare regulations and implementing operational processes.

• Strong leadership, communication, project management, analytical, and coaching skills.

• Ability to travel as business needs require.

Preferred Qualifications

• RAC-CT, RAC-CTA, or equivalent MDS certification.

• Experience leading multi-facility or multi-state MDS and reimbursement programs.

• Knowledge of Medicaid case-mix systems and managed care reimbursement processes.

• Experience with PointClickCare and reimbursement analytics platforms.

• Experience supporting acquisitions, integrations, or large-scale operational change initiatives.

Working Conditions

• Work in both office and skilled nursing facility environments.

• Frequent collaboration with facility leadership and interdisciplinary care teams.

• Travel to multiple facilities and states as business needs require.

• Occasional evening or weekend work may be necessary to support business operations.