AVP of Health Services: Quality and Reimbursement (Long Term and Residential Care) at Community First Solutions

Do you believe great leadership means advancing quality, accountability, and innovation in care delivery? Then we’re looking for YOU to join our team at Community First Solutions!

We are seeking an Assistant Vice President of Quality & Reimbursement to lead quality assurance, risk management, and reimbursement initiatives across our Health Services division. In this pivotal leadership role, you’ll ensure the delivery of exceptional, person-centered care while driving compliance, accuracy, and continuous improvement. You’ll partner closely with our AVP of Clinical and AVP of Health Services to align care quality with organizational excellence, strategic growth, and regulatory standards. This is a high-impact position where clinical insight, operational expertise, and strategic thinking come together to enhance outcomes, strengthen systems, and support our mission of serving others with excellence.

Why You’ll Love Us

• Mission-Driven Culture – At Community First, people come first — always. Our purpose is to serve others with excellence and care, creating communities where residents and staff can thrive.

• Purpose with Impact – Your leadership directly shapes the quality of care, regulatory integrity, and financial health of our organization.

• Collaboration & Influence – Work closely with executive leaders, clinical teams, and interdisciplinary partners to advance best practices across our campuses.

• Innovation & Improvement – You’ll have the autonomy to lead initiatives that elevate care delivery, strengthen compliance, and optimize reimbursement performance.

• Career Growth Opportunities – As part of a growing organization, you’ll have pathways to expand your leadership impact and shape the future of quality and care innovation.

• Perks You’ll Enjoy – Competitive compensation, employee recognition programs, professional development, and a supportive leadership culture that values excellence and results.

Why We’ll Love You

• You are a strategic, data-informed leader, capable of translating analytics into action to improve outcomes and maximize reimbursement accuracy.

• You have a deep understanding of MDS, PDPM, and quality measures, ensuring regulatory compliance while optimizing case mix and rate-setting performance.

• You thrive in a dynamic, growth-oriented environment, adapting strategies to meet evolving healthcare regulations, payer models, and organizational needs.

• You bring strong clinical and operational insight, effectively bridging nursing, therapy, and administration to achieve shared quality goals.

• You are a collaborative partner, building alignment between interdisciplinary teams to ensure a unified approach to care, compliance, and performance improvement.

• You demonstrate exceptional communication and leadership skills, fostering trust, accountability, and clarity across all levels of the organization.

• You maintain a continuous improvement mindset, leading QAPI and risk management efforts that drive measurable, sustainable results.

• You are proactive and solutions-focused, anticipating challenges and implementing systems that strengthen quality and compliance infrastructure.

• You lead with integrity, transparency, and excellence, ensuring every initiative reflects our mission and commitment to person-centered care.

Minimum Qualifications

• Education: Graduate of an accredited school of nursing or bachelor’s degree in Healthcare Administration.

• Licensure/Certification: RN or LNHA required.

• Experience: Minimum of 5 years of healthcare leadership experience, including MDS, reimbursement, risk management, compliance, and quality assurance/improvement (QAPI).

If you’re ready to bring your expertise to a mission that truly matters, we’d love to meet you.
Apply today and help us elevate quality, compliance, and care across our growing organization.

Leadership & Operations

• Collaborate with the AVP of Clinical and the AVP of Health Services to drive initiatives and best practice in our industry.
• Lead interdisciplinary care planning and coordination efforts with the MDS/ Therapy staff
• Monitor and accurately optimize quality measures, case mix and Residential Care Level of Care Assessments
• Census Management

Quality Assurance & Compliance

• Develop, implement, and monitor comprehensive quality assurance programs
• Lead preparation for state surveys, and other regulatory inspections
• Manage quality improvement initiatives and performance improvement projects
• Ensure compliance with CMS regulations, state licensing requirements, and accreditation standards
• Coordinate with AVP of Health Services and AVP of clinical on risk management, incident analysis and corrective action plans.
• Stay abreast of all new regulations and ensure teams are educated and trained in collaboration with AVP of Health Services and AVP of Clinical.
• Ensure appropriate level of care placements and clinical assessments in RCF.
• Ensure Level of Care Assessments in RCF are completed timely and accurately
• Ensure Process and procedure for ADR’s are completed accurately
• Oversee MDS staff and to ensure we are capturing appropriate reimbursement, meeting routinely with this team to review metrics.

Reimbursement Management

• Oversee compliance with Ohio Department of Medicaid (ODM) nursing facility payment methodologies and rate-setting processes
• Ensure compliance with Ohio's Quality Incentive Program and value-based payment initiatives
• Maintain expertise in Ohio Department of Health nursing home regulations with regard to quality & reimbursement implications
• Manage State-specific quality reporting requirements that impact reimbursement rates
• Oversee Minimum Data Set (MDS) assessment processes to ensure accurate coding and optimal reimbursement under PDPM (Patient Driven Payment Model)
• Develop and maintain MDS coding protocols to capture appropriate case-mix index while ensuring clinical accuracy and regulatory compliance
• Implement quality assurance programs for MDS assessments
• Manage MDS submission timelines to CMS QIES system and ensure compliance with assessment scheduling requirements (5-day, 14-day, 30-day, 60-day, and discharge assessments)
• Analyze PDPM payment components (PT, OT, SLP, Nursing, Non-Therapy Ancillary) to ensure appropriate resident classification and reimbursement
• Ensure accurate ICD-10 diagnosis coding to support appropriate PDPM case-mix assignments
• Develop processes to capture and document all relevant clinical conditions and functional deficits that impact payment classification
• Monitor PDPM payment adjustments and appeals processes for coding disputes
• Oversee MDS-based Quality Measures reporting to maintain and improve CMS Five-Star Quality Rating System scores
• Implement strategies to optimize performance on MDS-derived quality measures that impact reimbursement and market competitiveness
• Manage MDS data accuracy to support State quality reporting requirements
• Coordinate with clinical teams to ensure MDS assessments accurately reflect resident acuity and care needs

Strategic Planning & Operations

• Participate in strategic planning initiatives related to clinical services
• Analyze clinical and financial data to identify improvement opportunities
• Support census development and occupancy optimization efforts
• Collaborate on budget planning for clinical departments

Education:  Graduated from an accredited school of nursing, or bachelors degree in Healthcare administration with experience in LTC/RCF’s.

Licenses or other required certifications:  Must be an RN or bachelor’s degree in Healthcare Administration or LNHA

Experience:  At least five years of experience within the health care field to include experience with MDS, Risk-Management, Corporate Compliance, reimbursement and QAPI.

Specialized knowledge, skills, or abilities:

• Experience in health, long-term care management/billing required. Must possess familiarity with State and Federal regulations, Medicare/Medicaid, and other accreditation requirements
• Must possess the ability to make independent decisions when circumstances warrant such action
• Must possess the ability to seek out new methods and principles and be willing to incorporate them into existing practices
• Excellent analytical and abstract reasoning skills, plus excellent organizational skills.
• Must be computer proficient
• Must possess the ability to present professionally and deal tactfully with personnel, residents, family members, visitors, government agencies, employees and the general public.
• Must possess the ability to seek out new methods and principles and be willing to incorporate them into existing department practices
• Consistently demonstrates courteous and polite behavior. Is respectful, helpful and prompt in responding to needs and requests of customers. Listens for understanding to determine if clarification is needed. Demonstrates understanding of the company purpose and mission.
• Demonstrates an appropriate level of ability to achieve desired outcomes by setting goals and priorities for the team that deliver results. Resolves conflict effectively. Acts in a fair and just manner. Motivates and guides team members. Invests in the growth and development of team members. Models the behavior he/she expects of others. Attracts and retains a quality workforce.
• Consistently demonstrates the ability to perform job duties as outlined in the job description and other duties as assigned. Performs work in accordance with regulations, nursing policies and within budgetary constraints. The delivery of service is timely and appropriate. The work produced is thorough, accurate and complete, the quantity of work standards is met and is process-improvement oriented.
• Understands and adheres to the policies outlined in our employee handbook.
• Completes all mandatory in-service training within the designated time frames
• Demonstrates the ability to be accountable, dependable and trustworthy.