RN Revenue Integrity Lead - Flexible Remote

UChicago Medicine; Illinois; Remote; USD 120,000 - 160,000; Full time

Benefits offered by this job

Flexible remote work

Onsite when needed

Job summary

UChicago Medicine is seeking an RN Manager for the Revenue Cycle Department to lead a team of nurses focused on clinical revenue integrity and reimbursement optimization across the health system.

You will oversee staff partnering with physicians, case management, utilization management, patient access, coding, and payer organizations to reduce denials and maximize reimbursement through evidence-based appeals and robust clinical review.

Qualifications

• BSN required.
• 5+ years of progressive clinical experience in acute care, utilization management, case management, revenue cycle, clinical appeals, or related healthcare operations.
• Knowledge of medical necessity criteria, utilization review, payer authorization requirements, and clinical documentation standards.
• Experience with commercial and governmental payer appeals, clinical denials, and audit management.
• Current RN license in good standing.
• Certification in Case Management (CCM), Utilization Review (CPUR or equivalent), Revenue Cycle (CRCR, CRCE), or related professional certification preferred.

Responsibilities

• Provides direct leadership, coaching, and performance management for a team of Registered Nurses responsible for clinical revenue integrity and payer appeal activities.
• Establishes standardized workflows, productivity expectations, quality standards, and service level agreements for assigned functions.
• Develops departmental goals, monitors key performance indicators, and implements process improvements to enhance operational effectiveness and reimbursement outcomes.
• Fosters collaboration between Revenue Cycle, Utilization Management, Patient Access, Case Management, Coding, Clinical Documentation Integrity, Compliance, and physician leadership.
• Recruits, develops, mentors, and retains a high-performing team while promoting professional development and continuous learning.
• Serves as a subject matter expert on payer medical necessity requirements and clinical denial prevention strategies.
• Oversees nursing review of commercial, governmental, and recovery audit requests to ensure accurate and timely clinical responses.
• Ensures clinical documentation supports billed services and coordinates with appropriate stakeholders to develop audit responses.

Skills

Analytical skills

Problem solving

Critical thinking

Project management

Organizational skills

Process improvement

CMS regulations knowledge

Medical necessity review

Written communication

Education

Bachelor's degree in Nursing (BSN)

Tools

Electronic health records (EHR) systems

Payer portals

Utilization management systems

Revenue cycle applications

Job description

UChicago Medicine is seeking an RN Manager for the Revenue Cycle Department to lead a team of nurses focused on clinical revenue integrity and reimbursement optimization across the health system.

You will oversee staff partnering with physicians, case management, utilization management, patient access, coding, and payer organizations to reduce denials and maximize reimbursement through evidence-based appeals and robust clinical review.