Job Description

Job Title: Clinical Manager (RN) - Revenue Cycle Corporate Care Management
Job ID: 692323
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility:
Department: Rev Cyc Care Mgmt
Location: 2 Hot Metal Street, Pittsburgh PA 15203

Description

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. Ensures that department operations are functioning optimally, and work distribution and workflow processes are operating efficiently and in accordance with all regulatory guidelines. Responsible for staff development as well as team attainment of quality and productivity goals.

Responsibilities:
  • Aggressively manage Denial and Edit resolution processes and make improvements to minimize or eliminate.
  • Analyze data for trends and causative factors that promote or impede progression toward expected outcomes. Communicates identified trends to appropriate leadership.
  • Assist in the implementation and modification/creation of software to support areas related to scope of responsibility.
  • 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.
  • Complete or direct the completion of all necessary human resource documentation and adhere to all human resources expectations.
  • 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.
  • Ensure that all policies, procedures, job descriptions, reports and other documentation are properly maintained and issues addressed as required.
  • 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.
  • 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.
  • 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.
  • 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.)

Qualifications

  • Bachelors degree in Nursing or other Healthcare related field required
  • Pennsylvania RN License required 
  • Five (5) years experience in revenue cycle/care management/program development required 
  • Three to five years in a health care financial environment preferred
  • Knowledge of medical necessity criteria (InterQual) preferred
  • Knowledge of CPT-4 and Revenue Coding is strongly preferred
  • Prior appeal/grievance experience preferred
  • Knowledge of payer reimbursement structure preferred
  • 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

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $30.89 to $52.76

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.



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