Clinical Manager, Revenue Cycle CCM at UPMC

Pittsburgh, Pennsylvania, United States -

Full Time

Start Date

Immediate

Expiry Date

30 Mar, 26

Salary

0.0

Posted On

30 Dec, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Management, Revenue Cycle, Denial Management, Utilization Review, Staff Development, Analytical Skills, Communication Skills, Interpersonal Skills, Leadership, Quality Improvement, Healthcare Knowledge, Microsoft Office, Team Building, Problem Solving, Customer Satisfaction, Regulatory Compliance

Industry

Hospitals and Health Care

Description

Purpose: UPMC is hiring a full-time Clinical Manager, Revenue Cycle CCM to support the Pre-Arrival department. This role will work Monday through Friday during normal business hours and is eligible to work from home after training. The Clinical Manager, Revenue Cycle CCM 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. They ensure that department operations are functioning optimally, and work distribution and workflow processes are operating efficiently and in accordance with all regulatory guidelines. The Clinical Manager is responsible for staff development, as well as team attainment of quality and productivity goals. Do you have acute care authorizations or nursing experience? Do you have prior supervisor or management experience? If so, this could be the next step in your career. Submit your application today! 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. Bachelor's degree in Nursing or other Healthcare related field required. Pennsylvania State Nursing Licensure required. Five (5) years' experience in revenue cycle/care management/program development required. Previous supervisory or management experience preferred. Ability to build credible and effective relationships with physician leadership. Strong analytical skills. Proficient in Microsoft Office Applications and analytical/reporting tools. Keen understanding of clinical and revenue cycle processes. Excellent communication and interpersonal skills. Demonstrated leadership capabilities. Strong quality/process improvement expertise. Managed care and third-party payor experience (preferred). Denial Management experience (preferred). Understanding of clinical and authorization/utilization review processes (preferred). Licensure, Certifications, and Clearances: Pennsylvania State Nursing Licensure required Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran

Responsibilities

The Clinical Manager oversees the daily operations of authorization, denial management, and utilization review functions. They are responsible for staff development and ensuring that department operations are efficient and compliant with regulatory guidelines.