Clinical Manager, Revenue Cycle CCM

Purpose:

UPMC Corporate Revenue Cycle is hiring a Clinical Manager to join our Care Management Team! This role works Monday through Friday during daylight hours. The position is eligible to work remotely with possible on-site meetings 1-4 times per year.

The Clinical Manager is responsible for the direct oversight of the day-to-day operations of the authorization, denial management, and/or utilization review functions of UPMC Revenue Cycle, involving both clinical and non-clinical staff. The role will also ensure that department operations are functioning optimally, and work distribution and workflow processes are operating efficiently and in accordance with all regulatory guidelines. Additionally, this employee will be responsible for staff development, as well as team attainment of quality and productivity goals.

Do you have experience in utilization review? Do you have care management or revenue cycle experience? If so, this could be the next step in your career. Read on and apply today!

Responsibilities:

• Analyze data for trends and causative factors that promote or impede progression toward expected outcomes.

Communicate identified trends to appropriate leadership.

• Aggressively manage Denial and Edit resolution processes and make improvements to minimize or eliminate.

• Develop a high-performing team by identifying opportunities to enhance their knowledge and skills, providing training and mentoring, and promoting a collaborative team-focused work environment.

• Utilize the core values as the basis for management making them part of the recruitment, orientation and training for associates (respect, simplicity, integrity, inventiveness and customer services advocacy.)

• Prioritize work assignments as needed and adjust staffing to accommodate work volumes; provide guidance and assistance to staff in the completion of difficult duties/responsibilities and resolution of complex issues.

• Monitor and support daily staff functions by establishing, maintaining and modifying work standards and productivity/quality tools in all areas related to scope of the Manager's responsibility.

• Ensure that all policies, procedures, job descriptions, reports and other documentation are properly maintained and issues addressed as required.

• Complete or direct the completion of all necessary human resource documentation and adhere to all human resources expectations.

• Assist in the implementation and modification/creation of software to support areas related to scope of responsibility.

• Function as a resource person for authorization, denial management and/or utilization review processes.

• Assess and respond to organizational and customer needs with innovative programs to ensure customer satisfaction.

• Communicate regularly and effectively with subordinates and superiors, regarding the status and condition of the business operation under control of the Manager.

• Perform other duties as assigned.

• Bachelor's degree in Nursing or other Healthcare related field required.

• Pennsylvania State Nursing Licensure required.

• Five (5) years' experience in revenue cycle/care management/program development required.

• Previous supervisory or management experience preferred.

• Ability to build credible and effective relationships with physician leadership.

• Strong analytical skills.

• Proficient in Microsoft Office Applications and analytical/reporting tools.

• Keen understanding of clinical and revenue cycle processes.

• Excellent communication and interpersonal skills.

• Demonstrated leadership capabilities.

• Strong quality/process improvement expertise.

• Managed care and third party payor experience (preferred).

• Denial Management experience (preferred).

• Understanding of clinical and authorization/utilization review processes (preferred).

Licensure, Certifications, and Clearances:

• Pennsylvania State Nursing Licensure required
• Registered Nurse (RN)
• Act 34

Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state.

UPMC is an Equal Opportunity Employer/Disability/Veteran