Clinical Manager, Revenue Cycle CCM

UPMC; Pittsburgh (Allegheny County); Hybrid; USD 90,000 - 120,000; Full time

Job summary

UPMC is seeking a Clinical Manager to lead the Care Management Team within Corporate Revenue Cycle. The role oversees authorization, denial management, and utilization review functions, supervising both clinical and non-clinical staff.

Eligible for remote work with periodic on-site meetings (1–4 times per year). The Manager will ensure efficient operations, staff development, and attainment of quality and productivity goals in compliance with regulatory guidelines.

Qualifications

• Experience in utilization review.
• Care management or revenue cycle experience.
• Ability to lead and develop a high-performing team.
• Knowledge of regulatory guidelines.
• Strong communication with leadership.

Responsibilities

• Analyse data for trends and factors influencing outcomes.
• Aggressively manage denial and edit resolution processes.
• Develop a high-performing team through training and mentoring.
• Incorporate core values into recruitment, orientation and training.
• Prioritize work assignments and adjust staffing to volumes.

Skills

Utilization review experience

Care management

Revenue cycle

Data analysis

Staff development

Team leadership

Process improvement

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.