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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in MDS 3.0, PDPM, and regulatory compliance, with a strong focus on improving reimbursement outcomes and ensuring audit readiness. Capable of translating complex reimbursement rules into actionable insights for clinical and operational teams.
Highest-signal resume keywords
Expert Knowledge Of RAI ManualMDS 3.0 ProficiencyPDPM Implementation ExperienceActive RN LicenseRAC-CT Certification
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
MDS Accuracy ImprovementCase-Mix CaptureReimbursement AnalysisRegulatory ComplianceAudit Risk Management
Soft Skills
Clear CommunicationCollaboration With Clinical TeamsTraining And Education Development
Certifications & Qualifications
RAC-CTRAC-CTA
Industry Keywords
SNF Revenue OversightMedicare Part AMedicaid Case-MixPEPPERTPERACQuality MeasuresFive-Star Ratings
About the role
Key responsibilities & impact- Serve as Teton's subject-matter expert on the RAI Manual, MDS 3.0, PDPM, Section GG, Care Area Assessments and Quality Measures
- Map platform observations—including mobility, ADLs, sleep, falls, behaviors and staff interactions—to MDS items, look-back periods and PDPM components
- Define clinical and reimbursement requirements with product, data science and engineering teams
- Write specifications, 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
- Convert regulatory and reimbursement changes into product roadmap input
- Ensure reimbursement-related insights are defensible, audit-ready and documentation-supported
- Build guardrails preventing upcoding and flagging under-capture
- Advise on PEPPER, TPE, RAC and survey risk in feature design and positioning
- Partner with SNF operators' MDS coordinators, DONs, administrators and regional clinical reimbursement leaders to deploy Teton into 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
- Train commercial, customer success and product teams on SNF reimbursement fundamentals
- Develop playbooks, education content and clinical validation protocols as Teton scales across US portfolios
Requirements
What you’ll need- 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
Benefits
Comp & perks- Competitive salary
- Equity
- Benefits
- Opportunity to define how AI supports clinical reimbursement in skilled nursing
- Direct influence on product strategy at a fast-growing, venture-backed company
- Mission focused on better resident outcomes, reduced caregiver burden, and more predictable operator operations