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Clinical Operations Lead
HURC Healthcare SolutionsUR Clinical Operations Lead acting as a clinical consultant for large hospital systems. Focused on optimizing utilization review and denial management initiatives for healthcare organizations.
About the role
Key responsibilities & impact- 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.
Requirements
What you’ll need- Minimum of 7 years of Utilization Review, Case Management or Revenue Cycle experience.
- Minimum of 3 years working directly with hospital systems in a consulting or client-facing capacity.
- Strong understanding of: Hospital revenue cycle operations, Utilization management, Denial management, Medical necessity criteria, Payer regulations and reimbursement methodologies.
- Experience presenting in executive leadership and facilitating client meetings.
- Strong knowledge of Medicare, Medicaid, and commercial payer requirements.
- Experience with electronic medical records, preferably Epic.
- Excellent presentation and communication skills.
- Ability to build credibility and influence stakeholders at all levels.
- Strong analytical and problem-solving abilities.
- Self-directed with the ability to manage multiple client engagements simultaneously.
- Proficiency in Microsoft Office applications, particularly Excel and PowerPoint.
Benefits
Comp & perks- Up to 25% travel, as required by client engagements.
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Utilization ReviewCase ManagementRevenue CycleDenial ManagementMedical Necessity CriteriaPayer RegulationsReimbursement MethodologiesProcess ImprovementPerformance MetricsCompliance
Soft Skills
Presentation SkillsCommunication SkillsAnalytical AbilitiesProblem-SolvingStakeholder InfluenceRelationship BuildingMentoringSelf-DirectedOrganizational SkillsFacilitation