Clinical Reimbursement Manager (CRM)

Avir Trilogy · Houston, TX Full Time

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Job Description

Avir Trilogy - Clinical Reimbursement Manager (CRM) Position Summary The Clinical Reimbursement Manager (CRM) provides regional leadership, oversight, and strategic direction for clinical reimbursement operations across an assigned portfolio of skilled nursing facilities. This position is responsible for promoting accurate reimbursement, regulatory compliance, MDS accuracy, appropriate acuity capture, and strong clinical documentation practices while supporting facility leadership and MDS teams in achieving operational and financial performance goals. The Clinical Reimbursement Manager serves as a subject-matter expert in Medicare Part A, PDPM, Texas Medicaid PDPM-LTC, MDS 3.0/RAI requirements, Quality Measures, QIPP, managed care, and reimbursement compliance. The CRM works collaboratively with facility and regional leadership to identify reimbursement opportunities, mitigate compliance risk, strengthen clinical systems, and improve overall reimbursement performance. This is a field-based leadership position requiring regular travel throughout the assigned region and a consistent presence within assigned facilities. Essential Duties and Responsibilities Regional Reimbursement Leadership Provide clinical reimbursement oversight and leadership for an assigned portfolio of skilled nursing facilities. Monitor facility performance and identify opportunities related to Medicare, Medicaid, managed care, acuity capture, Case Mix Index (CMI), Quality Measures, and QIPP. Develop and implement regional strategies to improve reimbursement performance while maintaining regulatory and documentation integrity. Partner with Administrators, Directors of Nursing, MDS Coordinators, Regional Operations, Regional Clinical leadership, therapy providers, and other interdisciplinary partners. Establish clear expectations and accountability for facility reimbursement processes and outcomes. Maintain a consistent field presence within assigned facilities, spending a minimum of three (3) days per week facility-facing. Coordinate facility visits and regional coverage based on reimbursement performance, compliance risk, staffing needs, Quality Measure performance, QIPP outcomes, MDS vacancies, operational priorities, and other identified business needs. MDS and Regulatory Compliance Provide expert guidance regarding the MDS 3.0, RAI Manual, Medicare Part A, PDPM, Texas Medicaid PDPM-LTC, and applicable CMS and state requirements. Monitor MDS completion, accuracy, timeliness, and supporting clinical documentation. Review reimbursement practices to ensure services and coded conditions are supported by the medical record. Identify potential compliance concerns and implement corrective action plans. Support facilities during internal audits, external audits, ADRs, medical reviews, and other reimbursement-related reviews. Performance Management Analyze facility and regional reimbursement metrics. Identify underperforming facilities and develop targeted improvement plans. Conduct routine follow-up to ensure corrective actions result in measurable improvement. Provide leadership with concise reporting regarding performance, ris

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What Most Job Listings Don’t Tell You

General overview for this role type — specific duties and requirements vary by employer.

Management roles in senior living carry a unique blend of healthcare oversight and business operations that most job listings barely touch on. Executive Directors and Administrators are typically responsible for state regulatory compliance, staff retention, census management, and family satisfaction — all at the same time. In Texas, Assisted Living Facility administrators must meet HHSC licensing requirements, which often include specific training hours and ongoing continuing education.

What surprises many new administrators is the direct involvement with families during crises — end-of-life transitions, care disputes, and emergency situations all land on your desk. Staff turnover in senior living runs high nationally, so a significant part of the role is recruiting, training, and retaining quality caregivers. Facilities in the Houston market compete heavily for qualified staff, making retention strategy a critical skill for anyone in these positions.

What to Expect in This Role Day-to-Day

Based on typical senior living facilities in the Houston area.

A typical day starts with a census and staffing review — confirming occupancy, checking for any overnight incidents, and ensuring the day's shifts are fully covered. Morning stand-ups with department heads (nursing, dietary, activities, maintenance) set priorities for the day. You will spend time on the floor interacting with residents and families, which doubles as quality checks and relationship building.

Afternoons often shift to administrative work — reviewing financial reports, handling vendor relationships, preparing for state surveys, and managing marketing efforts to maintain occupancy. Community outreach, hospital discharge planner relationships, and local referral networks are ongoing responsibilities. Most directors describe the role as never having two identical days — the blend of clinical, operational, and interpersonal challenges keeps the work unpredictable but engaging.

Houston Area Salary Data

According to the Bureau of Labor Statistics, Medical/Health Services Manager positions in the Houston metro area earn a median wage of $59.81/hr ($124,405/yr). The typical range is $45.69 – $78.44/hr (25th–75th percentile).

Entry Level (10th) $73,403/yr

Houston Median $124,405/yr

Experienced (90th) $206,565/yr

vs. National Median +0.4%

Source: Bureau of Labor Statistics, Occupational Employment & Wage Statistics (Houston-Pasadena-The Woodlands, TX Metro Area). Salary data provided by Houston Senior Living Guide.