HURC Healthcare Solutions

Clinical Operations

• Serve as the primary clinical consultant for assigned hospital and health system clients.
• Build and maintain strong relationships with client leadership, including Case Management Directors, Revenue Cycle Leaders, Physician Advisors, and C-suite executives.
• Conduct assessments of utilization review processes and identify opportunities for operational improvement.
• Provide strategic recommendations to improve authorization processes, reduce denials, and optimize reimbursement.
• Facilitate client meetings, present findings, and communicate project updates to stakeholders.
• Support implementation of process improvements and monitor performance metrics.
• Review inpatient and outpatient utilization management processes for compliance and efficiency.
• Analyze denial trends, payer behavior, and utilization patterns.
• Collaborate with physician advisors and operational teams to improve medical necessity documentation and appeal success rates.
• Provide guidance on CMS, Medicare, Medicaid, and commercial payer requirements.
• Assist clients with length-of-stay management, authorization processes, and denial prevention strategies.
• Develop and implement best practices related to utilization management and revenue integrity.
• Educate client teams on regulatory changes, payer requirements, and industry best practices.
• Develop training materials, workflows, and standard operating procedures.
• Mentor and support internal consultants and clinical team members.
• Serve as a subject matter expert during client engagements and business development opportunities.

Clinical Operations Lead