Director, Clinical Revenue Cycle

TEKsystems•Chesapeake, VA

1d•$100,000 - $130,000•Hybrid

About The Position

Provides operational oversight and strategic planning and execution for all areas of the Clinical Revenue Cycle. The Director of Clinical Revenue Cycle is responsible for planning, organizing, coordinating, managing, implementing, evaluating, and developing all areas of the Clinical Revenue Cycle, including but not limited to, Utilization Review, Clinical Appeals, CDM Management, and Revenue Integrity. This position serves a critical role in acting as a liaison between clinical and non-clinical departments, ensuring positive financial outcomes that match the delivery of care received by patients. Must guide and direct the utilization team to provide optimal financial outcomes for the facility. This position develops and integrates strategies to ensure financial management, leadership, quality and operational management objectives. The Director functions as the internal resource on issues related to appropriate utilization of resources, coordination of care across the continuum and utilization review and management.

Requirements

Bachelor’s degree in healthcare administration, nursing, health informatics, business, or a related field.
Five years of management experience will be considered in lieu of degree.
Three (3) years of experience in direct patient care RN experience in an acute care environment.
Five (5) years of experience in Utilization Review or Case Management department performing utilization review activities, with at least two (2) years of utilization review for an acute care environment.
Experience with Epic EMR is required.
If the degree is in Nursing, an active RN license is required

Nice To Haves

Master’s degree
Certified Professional Coder CPC preferred.
Certified Case Manager (CCM) or Accredited Case Manager (ACM) within 2 years of eligibility.

Responsibilities

Supervise the performance of Utilization Review, Revenue Integrity, and CDM team members
Evaluate staff performance and productivity to ensure optimal use of resources
Direct the overall activities of the Utilization Review team and implement efficiency measures
Develop and achieve departmental goals and objectives to ensure organization metric goals are achieved
Perform random audits to ensure appropriateness and timeliness of Utilization Review activities
Monitor documentation in the software platforms for appropriate use
Work closely with peers and leadership team to ensure the timely resolution of issues
Maintain data and metrics to submit to the Revenue Cycle Committee
Report and develop timely reports to submit to the Utilization Management Committee as directed
Review Utilization Review plans annually, revising as necessary, and submit for approval by the Utilization Committee and Medical Executive Committee
Assist with development and maintenance of department budget and ensure that the department operates within the allocated funds
Manages all appeals related to denials for all payers
Implement strategies to reduce denials while optimizing revenue
Ensure all hospitalized patients have the correct admission status so that an appropriate claim can be submitted to the payer
Oversee and coordinate the Utilization Review program's development to include the hospital resources as necessary to support its success
Facilitate and foster staff and physician participation in the development and/or process revenue cycle operations
Engage in improvement activities and events that maximize financial support for the hospital
Communicate Utilization Review results through appropriate committees
Develop and implement a continuous process improvement plan

Benefits

Medical, Dental & Vision Coverage
Multiple medical plan options through Aetna, including HSA‑eligible plans
Tiered provider network with lower out‑of‑pocket costs for CRH providers
Prescription drug coverage and access to CRH pharmacy services
Comprehensive dental and vision plans
On‑site Quick Care Clinic and virtual care options
Employee‑only GLP‑1 Weight Loss Management Program (for eligible participants)
Smoking cessation, chronic disease management, and fitness programs
On‑site fitness center and wellness incentives through the HEALTHYme program
Retirement savings plans with employer match and vesting
Employer‑funded Health Savings Account (HSA) contributions (for eligible plans)
Financial wellness coaching and planning resources through UBS
Flexible Spending Accounts (Healthcare and Dependent Care)
Generous Paid Annual Leave (PAL) with rollover options
Observed paid holidays
Short‑ and long‑term disability coverage (employer-paid for eligible roles)
Employer‑paid life insurance and AD&D coverage
Optional voluntary life insurance for employees and dependents
Employee Assistance Program (EAP) with confidential counseling and legal/financial support
Critical illness, accident, and hospital indemnity plans
Identity theft protection, legal resources, and pet insurance