Job Description

Job Title: Senior Manager, Revenue Cycle Authorizations (RN) - Corporate Care Management
Job ID: 698396
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

Are you an experienced nurse in the field of care management or payor operations? Do you have a background in leadership and are ready to take the next step in your career in management? Consider this brand new opportunity!

UPMC Corporate Services is hiring a full-time Senior Manager to support our Revenue Cycle Authorizations operations, a division of Corporate Care Management.

This position will work daylight hours, Monday through Friday.

Responsible for overseeing the operations of the authorization and pre-service and clinical billing review processes of UPMC Revenue Cycle involving both clinical and non-clinical staff. Ensures that department operations are functioning optimally and appeal/denial review work distribution and workflow processes are operating efficiently and in accordance with all billing collections and compliance regulations. Maintains a results oriented profile to effectively manage the staff and the systems to access identify report and resolve business issues and needs. Monitors quality assurance indicators to ensure optimal departmental standards for quality, accuracy and timeliness are met.


Responsibilities:
  • Aggressively manages edit, denial and audit resolution processes and make improvements to minimize or eliminate. Analyzes data for trends and causative factors that promote or impede progression toward preferred outcomes, appropriately communicating identified trends.
  • Completes or directs the completion of all necessary human resource documentation and adherence to all human resources expectations. Develops and maintains collaborative and customer focused relationships with internal and external customers.
  • Maintains knowledge of current industry trends, enhances professional skills, and refines expertise through appropriate education/developmental activities and professional affiliations. Prioritizes work assignments as needed and adjusts staffing to accommodate work volumes; provides guidance and assistance to staff in the completion of difficult duties/responsibilities and resolution of complex issues.
  • Participates in the development of efficient workflow patterns, appropriate processes, thresholds and productivity benchmarks, and monitors department�s productivity, quality and outcomes to support overall department goal of lowering cost and improving net revenue. Assesses and responds to organizational and patient needs with innovative programs to ensure timely access and seamless patient flow. Participates in the planning, design, testing and implementation of such programs.
  • Utilizes the core values as the basis for management decisions, making them part of the recruitment, orientation and training process. Develops 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.

Qualifications

  • Bachelors degree in Health Care Administration, Business, Nursing or related field required.
  • 7 years of progressive experience in care management, patient access, revenue cycle, or healthcare operations required.
  • RN Licensure in the state of Pennsylvania required.
  • Demonstrated progressive management experience required.
  • Masters degree strongly preferred.
  • Managed care and third party payor experience preferred.
  • Knowledge of payor authorization and medical policy requirements.
  • Experience with denial management preferred.
  • Demonstrated leadership capabilities and ability to influence others.
  • Keen understanding of clinical and revenue cycle processes.
  • Must possess analytical problem solving skills as well as the ability to coordinate the work of others and communicate effectively with all levels of management. 
  • Must be highly agile, demonstrate critical thinking skills and able to function in a high-pressure environment with very little direct supervision.
Licensure, Certifications, and Clearances:
  • Registered Nurse

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

Salary Range: $33.94 to $57.47

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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