Clinical Operations Lead
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
UR Clinical Operations Lead acting as a clinical consultant for large hospital systems. Focused on optimizing utilization review and denial management initiatives for healthcare organizations.
Responsibilities:
- 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:
- 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:
- Up to 25% travel, as required by client engagements.
Similar Jobs
Associate Director, FSP Clinical Operations / FSP Program Lead
Associate Director managing FSP Clinical Operations for Parexel, a global CRO specializing in clinical research, focusing on improving health outcomes. Overseeing staff and client projects, ensuring quality and timely delivery.
Regional Clinical Operations Lead
Regional Clinical Operations Study Lead managing healthcare research projects and leading teams to deliver quality outcomes. Key focus on project management and collaboration with cross-functional teams.
Manager, Clinical Operations
Manager, Clinical Operations leading integration of project team activities at ICON. Responsible for strategic study operations and vendor management for global clinical trials.
Clinical Trial Manager – Clinical Operations
Clinical Trial Manager overseeing planning and delivery of clinical studies at RayzeBio. Leading cross-functional teams to ensure studies meet quality standards and timelines.
Manager, Clinical Operations – Line Manager
Manager overseeing Clinical Operations, responsible for team management and successful project execution at Parexel. Driving clinical research solutions and guiding projects in collaboration.
Manager, Clinical Operations – FSP
Manager overseeing a team for clinical operations at Parexel, ensuring project deliverables meet quality standards. Responsibilities include resource allocation, staff development, and client management.
Director, Clinical Operations – Online
Director managing clinical operations for online education at West Coast University. Ensuring clinical placements and compliance within a comprehensive educational framework.
Global Clinical Project Manager – Senior Project Manager
Project Manager responsible for overall project delivery and customer communication at Thermo Fisher Scientific. Leading projects in clinical environments with adherence to quality, time, and cost.
Director, Clinical Operations
Director of Clinical Operations at ICON overseeing clinical trials in a global healthcare organization. Design and analyze trials while ensuring compliance and quality across operations.
Clinical Trial Manager, Clinical Operations
Clinical Trial Manager overseeing clinical trials from vendor selection to CSR completion at Spyre Therapeutics. Collaborating with internal teams and CRO partners in a fast-paced biotechnology environment.
Clinical Project Manager
Project Manager coordinating the preparation and opening of hospitals while managing enterprise-wide projects for Emerus. Leading cross-functional teamwork and ensuring departmental readiness.
Clinical Operations Leader – PM
Clinical Operations Leader overseeing clinical project management and execution across trials. Engaging with stakeholders and ensuring timelines and quality standards are met.
Clinical Project Manager II – Oncology, NSCLC
Clinical Project Manager managing oncology trials remotely for Syneos Health. Supporting operational execution and delivery excellence in clinical studies for innovative oncology research.
Head of Clinical Operations
VP of Clinical Operations overseeing the strategic scaling of clinical operations for Flagler Health. Leading a distributed team and ensuring high-quality care delivery across patient populations.
Strategic Clinical Quality Manager
Clinical Quality Manager responsible for quality assurance and performance improvement in dialysis treatment. Leading initiatives and compliance with clinical regulations and best practices in patient care.
Strategic Clinical Quality Manager
Clinical Quality Manager responsible for monitoring quality assurance and performance improvements in dialysis services. Aiming for regulatory compliance and the highest patient care standards through proactive initiatives.
SSO Clinical Project Manager
CPM responsible for planning, executing, and reporting on assigned Global Drug Development studies. Ensures compliance with Novartis processes and regulatory requirements during trial execution.
Clinical Project Manager – Strong Regional/Global Experience
Project Manager overseeing interdisciplinary clinical research studies at Syneos Health. Managing timelines, quality, and deliverables while liaising with clients and coordinating project activities.
Clinical Project Manager – Regional or Global Experience
Clinical Project Manager overseeing interdisciplinary clinical research studies at Syneos Health. Ensuring compliance with regulations and managing project deliverables effectively.
Clinical Project Manager
CM Clinical Project Manager supporting the Department of Veterans Affairs' Electronic Health Record modernization. Managing clinical project management and change management initiatives.