Remote Associate Director, Clinical Ops (IBR)

IntelliResume; Minnesota; Remote; USD 113,000 - 193,000; Full time

Job summary

UnitedHealth Group is seeking an Associate Director of Clinical Operations to lead Clinical Itemized Bill Review (IBR) for payer clients. The role combines clinical leadership with revenue cycle expertise and a focus on reimbursement integrity.

Location is Plymouth, MN with a fully remote work style; the position is full-time, daytime schedule. Requires RN licensure and 5+ years in healthcare revenue cycle and leadership experience.

Qualifications

• Active, unrestricted RN license is required.
• 5+ years in healthcare revenue cycle or related operations.
• 2+ years reviewing inpatient/outpatient facility claims.
• 2+ years applying CMS guidelines and reimbursement methodologies.
• 1+ year of leadership experience managing clinical staff.

Responsibilities

• Lead day-to-day clinical operations for pre-payment and post-payment facility claim reviews.
• Manage and develop clinical leaders and staff to achieve productivity, quality, and financial objectives.
• Monitor operational performance and drive process improvements to enhance efficiency and outcomes.
• Partner with offshore resources to support consistent execution of clinical review activities.
• Serve as a senior clinical resource for complex inpatient and outpatient facility claim reviews.
• Apply advanced knowledge of CMS guidelines and reimbursement methodologies to identify reimbursement opportunities.
• Ensure review findings are clinically sound, compliant, and defensible.
• Act as the primary clinical SME for the IBR product and review methodologies.
• Participate in client, provider, and leadership discussions involving complex reimbursement and billing issues.
• Lead the development and maintenance of clinical review concepts, reimbursement policies, and audit methodologies.

Skills

RN license

Healthcare revenue cycle

Leadership

CMS guidelines

Process improvement

Cross-functional collaboration

Education

RN licensure

Job description

UnitedHealth Group is seeking an Associate Director of Clinical Operations to lead Clinical Itemized Bill Review (IBR) for payer clients. The role combines clinical leadership with revenue cycle expertise and a focus on reimbursement integrity.

Location is Plymouth, MN with a fully remote work style; the position is full-time, daytime schedule. Requires RN licensure and 5+ years in healthcare revenue cycle and leadership experience.