Clinical Manager, Revenue Cycle CCM

UPMC; Northern (KY); Hybrid; USD 90,000 - 110,000; Full time

Job summary

UPMC Corporate Revenue Cycle is seeking a Clinical Manager to lead the Care Management Team. The position offers daytime hours with potential remote work and periodic on-site meetings 1-4 times annually.

The role oversees day-to-day operations of authorization, denial management, and utilization review, managing both clinical and non-clinical staff, ensuring efficient workflow and regulatory compliance, and driving staff development and quality outcomes.

Responsibilities

• Analyze data for trends and causative factors and communicate findings to leadership.
• Aggressively manage Denial and Edit resolution processes and drive improvements.
• Develop a high-performing team through training, mentoring and collaboration.
• Incorporate core values in recruitment, orientation and training of staff.
• Prioritize work assignments and adjust staffing to match volumes.
• Monitor daily staff functions and maintain productivity/quality tools.
• Ensure policies, procedures and job descriptions are up to date and comply with regulations.
• Complete HR documentation and adhere to HR expectations.
• Assist in implementing software supporting areas of responsibility.
• Serve as a resource for authorization, denial management and utilization review processes.
• Respond to organizational and customer needs with innovative programs for satisfaction.
• Communicate status with subordinates and superiors about business operations.

Skills

Data analysis

Team leadership

Utilization review

Staff development

Job description

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.

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.