Director of Clinical Reimbursement, Skilled Nursing

Location: Remote US; travel to key clientele as needed, approximately 10%

Company

hirify.global is building an AI and computer vision platform that provides predictive intelligence for senior care, helping caregivers, operators, and owners understand care activity and improve outcomes.

What you will do

• Serve as the subject-matter expert on the RAI Manual, MDS 3.0, PDPM, Section GG, Care Area Assessments, and Quality Measures.
• Map platform observations such as 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; write specifications, review models, and validate outputs against real assessments.
• Monitor CMS, RAI Manual, Five-Star, SNF VBP, and state Medicaid case-mix changes and convert them into product roadmap input.
• Build compliance guardrails, support audit-ready insights, and prevent upcoding while flagging under-capture.
• Partner with SNF operators, quantify reimbursement and quality outcomes, support ROI cases, represent hirify.global externally, and train commercial, customer success, and product teams.

Requirements

• 5+ years of direct national-level MDS and SNF revenue oversight, such as corporate or multi-region Director/VP clinical reimbursement experience at a multi-facility SNF operator.
• Expert, current knowledge of the RAI Manual, MDS 3.0, PDPM, Section GG, Medicare Part A, and Medicaid case-mix reimbursement.
• Working knowledge of state Medicaid case-mix systems across multiple states and regional practice differences.
• Track record of improving MDS accuracy, case-mix capture, and reimbursement outcomes across a facility portfolio.
• Strong understanding of PEPPER, TPE, RAC, survey, compliance, and audit risks, with a commitment to accurate and defensible coding.
• Active RN license, or LPN/LVN license with equivalent senior experience.
• RAC-CT, RAC-CTA, or equivalent AAPACN certification.
• Ability to explain complex reimbursement rules clearly to clinicians, engineers, and executives.

Nice to have

• Experience translating clinical knowledge into technology through product or engineering collaboration, requirements definition, or validation of software, analytics, or AI outputs.
• Client-facing experience in consulting, health tech, EHR, or software vendor roles serving SNF operators.
• Familiarity with SNF EHRs such as PointClickCare or MatrixCare and MDS data analytics.
• Experience presenting to operator executives, REITs, or senior housing asset owners.
• Exposure to SNF quality programs including Five-Star, SNF QRP, and SNF VBP and their relationship to reimbursement.

Culture & Benefits

• Opportunity to 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.
• Mission focused on better resident outcomes, reduced caregiver burden, and more predictable operator workflows.
• Competitive salary, equity, and benefits.