What are the responsibilities and job description for the Divisional Director of Clinical Reimbursement position at Creative Solutions in Healthcare?
Join Our Team as a Divisional Director of Clinical Reimbursement
Ensure Accuracy. Maximize Compliance. Support Quality Care.
We’re seeking an experienced and detail-oriented Divisional Director of Clinical Reimbursement to join our corporate team. The Divisional Director of Clinical Reimbursement provides strategic oversight, leadership, and operational support for clinical reimbursement across assigned divisions. This role ensures revenue integrity, regulatory compliance, quality measure optimization, and staff development while partnering closely with Regional Reimbursement Nurses (RRNs), facility teams, Quality Resource Managers (QRMs), and corporate leadership.
Your Impact as a Divisional Director of Clinical Reimbursement
In this role, you will:
-
Optimize revenue performance
- Lead ongoing reviews of Medicare and Medicaid rates, therapy utilization, PDPM/HIPPS trends, Medicaid forms, and billing accuracy.
- Partner with RRNs and facility leaders to address risks, implement action plans, and prevent revenue loss.
-
Advance quality outcomes and star ratings
- Oversee monthly review of Quality Measures, 5‑Star results, and QRP compliance.
- Collaborate with QIPP and facility teams to drive RCAs, PIPs, and improvement in underperforming facilities.
-
Ensure compliance and survey readiness
- Maintain oversight of MDS accuracy, UDAs, PASRR processes, month‑end completion, and system integrity.
- Support health survey outcomes, plans of correction, and CHOW coordination.
-
Develop strong, accountable teams
- Train, coach, and support RRNs and MDS staff while validating reporting and visit compliance.
- Contribute to performance evaluations, advancement planning, and bonus recommendations.
-
Serve as a strategic partner
- Work closely with the VP of Clinical Reimbursement, DVPs, QRMs, and operations leaders to align reimbursement strategy with operational goals.
What Makes You a Great Fit
We’re looking for someone who has:
-
Expertise in clinical reimbursement
- Strong working knowledge of MDS, PDPM, Medicare, Medicaid, QMs, QRP, and regulatory requirements.
-
Proven leadership capability
- Experience leading, developing, and influencing RRN and MDS teams across multiple sites or regions.
-
Analytical and systems aptitude
- Ability to interpret data and trends using tools such as CoreCare, DataIQ, PCC, and SimpleLTC.
-
Compliance‑focused mindset
- Track record of ensuring accuracy, timeliness, and survey readiness.
-
Collaborative leadership style
- Strong communication skills and a consultative approach to partnering with operations and corporate leaders.
Benefits (Full-Time)
-
Comprehensive Coverage: Health, Dental, and Vision Insurance
-
Extra Protection: AD&D, Short-Term Disability, Cancer, Critical Illness, and more
-
Life Insurance: Whole and Term Policies
-
Professional Growth: Tuition Reimbursement for continued education
-
Time to Recharge: Paid Time Off
-
Retirement Planning: Immediate 401(k) eligibility
-
Unwavering Support: Exceptional corporate resources and leadership
Equal Opportunity Employer
We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.