Associate Director, Clinical Operations – Itemized Bill Review (IBR) - Remote
About The Position
Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. The Associate Director of Clinical Operations is responsible for leading Clinical Itemized Bill Review (IBR) operations supporting UnitedHealthcare and commercial payer clients. As a Registered Nurse with extensive expertise in healthcare revenue cycle, facility reimbursement, and payment integrity, this leader drives clinical review strategies that identify reimbursement opportunities, support accurate claim adjustments, and ensure compliance with CMS guidelines and client requirements. This role provides leadership for a team of clinical leaders and reviewers, while partnering with resources to support operational consistency and business objectives. The Associate Director serves as the primary clinical subject matter expert for the IBR product, supporting complex client and provider discussions involving inpatient and outpatient facility billing, reimbursement methodologies, and adjustment rationale. The position plays a critical role in advancing product strategy, developing clinical review methodologies, and delivering significant financial value through accurate, defensible, and clinically sound claim reviews. This position combines clinical leadership with deep expertise in facility reimbursement and healthcare revenue cycle operations. The Associate Director serves as a trusted advisor and recognized subject matter expert, influencing clinical review methodology, product strategy, client outcomes, and reimbursement accuracy across a high-impact payment integrity program. The Associate Director functions as a recognized authority on facility reimbursement and payment integrity, influencing policy, product strategy, client outcomes, and significant savings opportunities across a multi-million-dollar business. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Requirements
- Active, unrestricted Registered Nurse (RN) license
- 5+ years of experience in healthcare revenue cycle, payment integrity, facility reimbursement, or related healthcare operations
- 2+ years of experience reviewing and analyzing inpatient and outpatient facility claims
- 2+ years of experience applying CMS guidelines, UB-04 billing requirements, revenue codes, MS-DRGs, APCs, hospital charging practices, and reimbursement methodologies
- 1+ year of leadership experience managing clinical staff and leading cross-functional initiatives
- 1+ year of experience presenting complex adjustment rationale and reimbursement concepts to clients, providers, and senior leadership
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
- Candidates are required to pass a drug test before beginning employment.
Nice To Haves
- Facility Payment Integrity Expertise
- Healthcare Revenue Cycle Knowledge
- Clinical Reimbursement Analysis
- CMS Regulatory Expertise
- Strategic Leadership
- Client & Provider Consultation
- Operational Excellence
- Process Improvement & Innovation
- Relationship Management
- Executive Communication
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, hospital billing practices, reimbursement methodologies, and payment integrity concepts to identify reimbursement opportunities and support adjustment recommendations
- 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
- Clearly communicate adjustment rationale, clinical findings, and reimbursement concepts to internal and external stakeholders
- Support escalated client and provider inquiries requiring advanced clinical and reimbursement expertise
- Lead the development and maintenance of clinical review concepts, reimbursement policies, and audit methodologies
- Partner with product and technology teams to enhance review capabilities and operational effectiveness
- Monitor regulatory and industry changes to ensure review methodologies remain current and effective
Benefits
- a comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Manager
