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VP, Clinical Reimbursement
VP, Clinical ReimbursementEncore Village of Schaumburg • Schaumburg, Illinois
VP, Clinical Reimbursement

VP, Clinical Reimbursement

Encore Village of Schaumburg • Schaumburg, Illinois
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Overview :

The Vice President of Clinical Reimbursement provides enterprise-wide leadership and oversight for MDS, case mix, and clinical reimbursement strategies. This role ensures the accuracy of clinical documentation, regulatory compliance, and maximization of reimbursement opportunities across all post-acute and long-term care facilities. The VP serves as a key liaison between clinical, operational, and financial teams and plays a critical role in optimizing quality of care and financial performance.

Key Responsibilities :

Strategic & Operational Leadership

  • Lead corporate-level strategy for MDS, PDPM, case mix, and clinical reimbursement.
  • Supervise and mentor Regional MDS Directors, Clinical Reimbursement Specialists, and other support staff.
  • Support acquisition integration from a documentation and reimbursement standpoint.

Resident Assessment & Care Planning

  • Oversee MDS assessment accuracy, care planning processes, and interdisciplinary documentation.
  • Ensure timely completion and submission of MDS in compliance with CMS regulations.
  • Regulatory & Compliance Oversight

  • Ensure compliance with federal / state regulations, including CMS, HCFA, PDPM, and Medicaid CMI guidelines.
  • Monitor audits (including RAC), survey readiness, and take corrective actions as needed.
  • Conduct internal audits to ensure documentation and coding integrity.
  • Financial Reimbursement Optimization

  • Partner with finance, billing, and operations to drive accurate reimbursement through clinical documentation.
  • Analyze case mix and MDS data to inform performance improvement and revenue integrity.
  • Stay current on CMS updates, ICD-10 coding, PDPM changes, and reimbursement methodologies.
  • Training & Development

  • Develop and deliver training for MDS Coordinators, DONs, and interdisciplinary clinical staff.
  • Serve as a clinical reimbursement resource and educator across all levels of the organization.
  • Quality & Performance Improvement

  • Review and act on Quality Measures (QMs) and case mix data to support care quality and compliance.
  • Participate in continuous improvement initiatives related to documentation, outcomes, and financial health.
  • Qualifications :

  • Registered Nurse (RN) license required.
  • Bachelor’s degree in Nursing or Healthcare Administration required; Master’s preferred.
  • MDS Certification strongly preferred.
  • 10+ years of experience in long-term / post-acute care with focus on MDS and reimbursement.
  • 5+ years in a regional or corporate leadership role.
  • Expertise in MDS 3.0, PDPM, RAI guidelines, Medicare / Medicaid regulations, and care planning.
  • Preferred Attributes :

  • Strong knowledge of ICD-10 coding, quality measures, and EMR / MDS systems (e.g., PointClickCare, MatrixCare).
  • Proven ability to lead, train, and coach multi-level teams.
  • Excellent analytical, communication, and organizational skills.
  • Work Location & Conditions

  • Travel : Up to 50% to locations, including 2-4 days of traveling twice per month to facility locations, referral meetings and any industry-related events
  • Environment : Corporate office and Skilled Nursing Facility (SNF) settings
  • Candidate should preferably reside in Eastern Time Zone or Central Time Zone for travel and operational alignment.
  • Encore Village does not discriminate in hiring or employment on the basis of ancestry, race, color, religion, national origin, sex, sexual orientation, age, military status, veteran status, or disability. No question on the application is intended to secure information to be used for such discrimination. This application will be given every consideration; however, its receipt does not imply employment for the applicant.

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    Clinical Reimbursement • Schaumburg, Illinois

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