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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.
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Utilization ReviewCase ManagementRevenue CycleDenial ManagementMedical Necessity CriteriaPayer RegulationsReimbursement MethodologiesProcess ImprovementPerformance MetricsCompliance
Soft Skills
Presentation SkillsCommunication SkillsAnalytical AbilitiesProblem-SolvingStakeholder InfluenceRelationship BuildingMentoringSelf-DirectedOrganizational SkillsFacilitation
Tools & Technologies
Electronic Medical RecordsEpicMicrosoft OfficeExcelPowerPoint
Industry Keywords
Hospital SystemsUtilization Management Best PracticesLength-of-Stay ManagementAuthorization ProcessesDenial Prevention StrategiesCMSMedicareMedicaidCommercial Payer RequirementsOperational Improvement
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.