Vice President of Utilization Review
Exact Billing Solutions
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Benefits offered by this job
Job summary
Qualifications
- Minimum 10 years of experience in operations management within healthcare or RCM industry.
- 5–7 years of experience in utilization review or related healthcare management role.
- Experience in providing leadership and direction to enhance customer relationships.
Responsibilities
- Oversee the strategic direction and operational efficiency of revenue cycle management functions.
- Collaborate with departments to achieve optimal patient outcomes.
- Serve as the point of escalation for complex UR cases.
Skills
Education
Tools
Job description
Lauderdale Lakes, FL – In Office – No Remote
Salary Range: $200K – $230K
This is a full‑time, on‑site role requiring daily presence at our Lauderdale Lakes, FL location.
Exact Billing Solutions is a unique team of revenue cycle management professionals specializing in the substance use disorder, mental health, and autism care fields of healthcare services. We have extensive industry knowledge, a deep understanding of the specific challenges of these markets, and a reputation for innovation. With our proprietary billing process, EBS is the oil that brings life to the engines of its partner healthcare companies.
EBS is poised for exponential growth, and we are building out our teams to support the expansion of global operations.
Part of the ICBD family office portfolio, Exact Billing Solutions combines entrepreneurial speed with the financial discipline of a self‑funded, founder‑led organization. Our growth reflects a proven ability to solve complex healthcare challenges with operational precision, scalable systems, and client‑first innovation.
Exact Billing Solutions was launched to address one of healthcare’s most persistent challenges: the burden of billing and insurance administration on providers. With firsthand knowledge of how inefficiencies in revenue cycle management drain resources from patient care, our founder built a company dedicated to removing obstacles, accelerating cash flow, and delivering peace of mind to clients across specialties.
- Inc. 5000, 2024 – Top 5 Fastest‑Growing Private Companies in America (ABA Centers of America)
- Florida Trend Magazine – 500 Most Influential Business Leaders
- EY Entrepreneur Of The Year® U.S. Overall
The Vice President of Utilization Review is responsible for overseeing the strategic direction and operational efficiency of revenue cycle management (RCM) functions, heavily focused on Out of Network (OON) with growing focus on In‑Network (INN) and Medicaid. This is more than just an operational leadership role—it is an opportunity to drive business transformation, guide the organization to market, and be a key player in a high‑growth, high‑impact journey. The Vice President will be instrumental in shaping the future of RCM commercialization and will influence the broader trajectory of the company's expansion and success.
The Vice President of Utilization Review will play a central role in implementing operational best practices, building scalable processes, and ensuring the seamless delivery of services while enhancing the company's competitive advantage in the industry. This role demands a strategic thinker with a deep understanding of RCM, a proven track record in operational leadership, and a passion for driving transformative change within a rapidly growing organization.
The principal functions of the position identified shall not be considered as a complete description of all the work requirements and expectations that may be inherent in the position. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the position.
- Collaborate with various departments, including medical staff, finance, case management, and quality assurance, to achieve optimal patient outcomes and financial performance.
- Provide supervision and guidance to UR team, ensuring adherence to processes and protocols.
- Serve as the point of escalation for complex UR cases and assist the team in developing strategies for challenging negotiations.
- Conduct ongoing audits of UR team members and report findings back to leadership.
- Collaborate closely with the UR Director to implement process improvements and support the team's alignment with organizational goals.
- Coordinate with clinical teams to support the department in gathering necessary documentation and developing individualized treatment plans for insurance submissions.
- Monitor team performance, provide regular feedback, and facilitate professional development opportunities.
- Build and scale high‑performing teams that drive efficiency, accountability, and results.
- Develop and refine client onboarding, integration, and management processes to support a growing external client base.
- Shape the go‑to‑market strategy, working closely with business development and operational leaders to ensure seamless execution.
- Leverage AI and automation to create a best‑in‑class RCM platform that differentiates us in the market.
- Serve as the face of the company both internally and externally, representing our commitment to excellence and driving the vision forward; lead with confidence, strategic foresight, and the ability to inspire teams to execute with precision.
- Externally engage with clients, partners, and industry stakeholders to ensure our value proposition resonates and meets the expectations of a growing client base; nurture relationships, secure buy‑in, and demonstrate the unique advantages of our RCM offering while fostering a collaborative and partnership‑driven environment.
- Inspire a culture of accountability, high performance, and continuous improvement. Ensure operational health while creating an environment where teams feel empowered to excel, collaborate, and innovate.
- Bachelor's degree in Business Administration, Healthcare Management, or a related field. An MBA or other advanced degree is highly preferred.
- Minimum of 10 years of experience in operations management, with at least 5 years in a senior leadership role within the healthcare or RCM industry.
- Minimum 5–7 years of experience in utilization review or a related healthcare management role.
- Experience providing leadership and direction to a team to maintain and enhance customer relationships to meet the company objectives.
- Proven track record of successfully scaling operations and leading large, cross‑functional teams.
- Experience with automation and AI integration in operational processes is a significant advantage.
- Strong strategic thinking and problem‑solving skills, with the ability to translate vision into actionable plans.
- Excellent leadership and team‑building skills, with a focus on fostering a culture of accountability and high performance.
- Exceptional communication and interpersonal skills, capable of engaging effectively with clients, partners, and internal teams.
- Proficiency in data analysis and performance metrics, with a keen eye for identifying trends and opportunities for improvement.
- Ability to manage multiple priorities in a fast‑paced, dynamic environment.
- Familiarity with RCM software and tools, as well as general IT systems used in healthcare operations.
- Understanding of AI and automation technologies and their application in RCM processes.
- Deep understanding of the healthcare industry, specifically out‑of‑network RCM, including regulatory requirements and payer landscapes.
- Knowledge of market trends and best practices in RCM and healthcare operations.
- High level of integrity and ethical standards.
- Strong executive presence and the ability to inspire confidence and trust.
- Adaptability and resilience in the face of challenges and change.
- 21 paid days off (15 PTO days, increasing with tenure, plus 6 holidays).
- Flexible Spending Account (FSA) and Health Savings Account (HSA) options.
- Medical, dental, vision, long‑term disability, and life insurance.
- Generous 401(k) with up to 6% employer match.
Exact Billing Solutions is committed to building a culture of professionalism, accountability, and operational excellence. We believe billing is more than a back‑office function—it’s a vital part of delivering quality healthcare. By hiring individuals with the right blend of expertise, integrity, and client focus, we empower providers to thrive while making the business of healthcare more efficient and sustainable.
Join our mission and help transform healthcare billing with precision and purpose!
Exact Billing Solutions participates in the U.S. Department of Homeland Security E‑Verify program.
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