Remote Clinical Manager – Care Management & Denial

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

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.