THIS IS FOR A FUTURE OPENING
Regional Clinical Reimbursement Consultant – State Veterans Homes
STGi is seeking qualified candidates for this position in connection with an active Request for Proposals (RFP). Hiring for this role is contingent upon STGi’s selection as the successful awardee.
JOB SUMMARY:
The Regional Clinical Reimbursement Consultant (RCRC) provides leadership and oversight of clinical reimbursement processes across multiple long-term care facilities within an assigned region. This role ensures accurate and compliant MDS completion, optimized reimbursement under PDPM, regulatory compliance, and consistent application of best practices while partnering with clinical, financial, and operational leaders to drive outcomes. Travel is required and is extensive throughout assigned region.
ESSENTIAL FUNCTIONS:
Clinical Reimbursement & PDPM Oversight
Oversee clinical reimbursement operations across multiple skilled nursing facilities
Ensure accurate, timely, and compliant completion of MDS assessments in accordance with CMS requirements
Monitor PDPM performance, case-mix accuracy, and reimbursement trends
Identify opportunities to optimize reimbursement while maintaining clinical integrity and compliance
MDS & Documentation Support
Provide guidance and oversight to MDS Coordinators and facility leadership
Ensure interdisciplinary documentation supports clinical conditions, diagnoses, and care needs
Support MDS scheduling, care area assessments (CAAs), and care planning processes
Compliance & Audit Management
Ensure compliance with federal and state regulations, RAI Manual, and payer requirements
Support internal and external audits, including medical record reviews and ADRs
Lead corrective action plans related to MDS, documentation, and reimbursement findings
Education & Training
Develop and deliver ongoing education related to PDPM, MDS, ICD-10 coding, and documentation standards
Support onboarding and competency development of MDS and clinical reimbursement staff
Stay current on CMS updates, rule changes, and industry best practices
Reporting & Analytics
Review and analyze reimbursement and quality data, including PDPM components, case-mix indices, and revenue impacts
Provide regular reporting and recommendations to regional and corporate leadership
Partner with business office and clinical teams to resolve billing, denials, and reimbursement issues
Collaboration & Leadership
Work closely with Regional Clinical, Operations, and Finance leadership
Serve as a regional resource for reimbursement-related questions and problem resolution
Promote a culture of compliance, accuracy, and continuous improvement
REQUIRED EXPERIENCE AND SKILLS:
Required
Active Registered Nurse (RN) license in good standing
Bachelor’s degree in Nursing or related field (BSN required)
Minimum 5–7 years of MDS and clinical reimbursement experience in long-term care
Strong knowledge of PDPM, RAI Manual, ICD-10 coding, and CMS regulations
Experience supporting audits and survey processes
Ability to travel regularly within assigned region
Preferred
Prior regional or multi-facility reimbursement leadership experience
RAC-CT, DNS-CT, or similar certification
Master’s degree in Nursing, Healthcare Administration, or related field
Skills & Competencies
Strong analytical and financial acumen
Excellent attention to detail and regulatory knowledge
Effective leadership, coaching, and education skills
Clear written and verbal communication
Ability to manage multiple facilities and priorities
REQUIRED EDUCATION:
Active Registered Nurse (RN) license in good standing
Bachelor’s degree in Nursing or related field (BSN required)
WORKING CONDITIONS/PHYSICAL REQUIREMENTS:
The physical demands and work environment described herein is a representative of those that generally must be met by a team member to successfully perform the essential functions of this job:
• This position primarily involves sitting, standing, walking, twisting, reaching, bending/stooping, pushing and pulling (typical weight of 5 lbs. and maximum weight of 100 lbs., approximately), and lifting (minimum weight of 5 lbs. and maximum weight of 100 lbs., approximately)
• The position requires repetitive finger movements as well as hearing and talking on the phone and in person.
• Must be able to continuously deal effectively with stress created by residents, multiple tasks, noises, interruptions, and work cooperatively as part of the health care team while maintaining a pleasant attitude
DISCLAIMER
The preceding job description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.
STGi is a workforce solutions company providing comprehensive healthcare delivery, Head Start and management consulting services and human capital solutions help our clients. Our services and solutions help our clients sustain and enhance their operations to better accomplish their mission.
STGi offers a competitive benefits package which includes Medical, Dental, Vision, 401k with company match and a generous PTO policy.
STGi is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class.
Medical Corps - 60J, 60L, 61F, 61H, 61N, 61R,62B Medical Specialist Corps - 65B, 65C, 65D Nurse Corps - 66B,66H, 66P Medical Service Corps – 67G, 67J Medical CMF – 68A, 68B, 68E, 68F, 68G, 68J, 68Q, 68R, 68S, 68T, 68W, 68X, 68Y
REQUIRED EXPERIENCE AND SKILLS:
Required
Active Registered Nurse (RN) license in good standing
Bachelor’s degree in Nursing or related field (BSN required)
Minimum 5–7 years of MDS and clinical reimbursement experience in long-term care
Strong knowledge of PDPM, RAI Manual, ICD-10 coding, and CMS regulations
Experience supporting audits and survey processes
Ability to travel regularly within assigned region
Preferred
Prior regional or multi-facility reimbursement leadership experience
RAC-CT, DNS-CT, or similar certification
Master’s degree in Nursing, Healthcare Administration, or related field
Skills & Competencies
Strong analytical and financial acumen
Excellent attention to detail and regulatory knowledge
Effective leadership, coaching, and education skills
Clear written and verbal communication
Ability to manage multiple facilities and priorities
Regional Clinical Reimbursement Consultant – State Veterans Homes • Wilmington, NC, US
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