Director of Clinical Utilization Review (RN)

EvidenceCare•Nashville, TN

4d•Hybrid

About The Position

The Clinical Director role focuses on providing clinically driven subject matter expertise with an emphasis on the AdmissionCare product. This role will directly drive value for our clients, as well as provide ongoing internal clinical insight, including client feedback and scale efforts across partners. The Clinical Director partners closely with Client Success Executives, Implementation, and the analytics team, to deliver key clinical support in the following areas: pre-go-live activities, on-site client go-lives, training, ongoing monthly meetings, Quarterly Business Reviews (QBRs), and ad-hoc touch points. This position is also responsible for developing and scaling clinically related initiatives for the AdmissionCare product, to streamline processes and contribute to meeting company growth goals.

Requirements

Minimum of three years of clinical experience (acute care)
Minimum of three years of revenue cycle experience (UR, UM, appeals)
Active RN License (Individual or Mutli-State)
Bachelor’s Degree required, master's degree preferred (nursing, business, or other clinical disciplines)
Experience with InterQual/MCG to complete medical necessity reviews and/or ensure compliance with regulatory and payer requirements
Proficiency in Microsoft Office (Outlook, Word, Excel, PowerPoint, Visio)
Skilled in utilizing business intelligence platforms for data analysis and reporting
Experienced in public speaking and stakeholder engagement
Strong critical thinking skills coupled with an ability to decipher and trend data.
Ability to work autonomously and prioritize workload effectively
Strong commitment to the values of the organization: Grit, Innovation, Integrity, Respect, Teamwork and Fun
Ability to work 3 days a week in-office (Nashville-based)

Responsibilities

Reports directly to the Clinical Delivery Executive, and offers supplemental clinical support for assigned responsibilities.
Assists in the development and maintenance of training initiatives and assesses user proficiency with the AdmissionCare product.
Works closely with Client Success Executives (CSEs) to assess and analyze clinical insights for customers utilizing the product(s).
Collaborates with CSEs on client narratives and reporting to drive end-user value.
Utilizes EvidenceCare’s (EC) BI tool to produce reports for KPIs and to assess client performance.
Utilizes analytics to create client focused narratives surrounding clinical/provider use of the tool, clinical insights, and areas for improvement
Works closely with Analytics vertical to provide feedback for reporting enhancements and to translate client requests.
Works directly with the Implementation team by participating in active projects and supporting clients during the integration efforts to assess workflow and train customers in AdmissionCare. This will require travel to client sites to assist with go-lives.
Proactively identifies opportunities for client education and process improvement within the AdmissionCare product.
Works closely with CSEs and Clinical Delivery Executive to capture training and process improvement needs.
Expert knowledge of AdmissionCare product to serve as both a clinical and product subject matter expert (SME).
Proactively identifies opportunities for internal and client related AdmissionCare workflow efficiencies.
Contributes to EvidenceCare’s efforts to create and scale internal processes.
Utilizes clinical and guideline (IQ, MCG) knowledge to answer client questions, address feedback, and make suggestions for product improvements.
Contributes to the creation of playbooks, templates, and tools to create effective processes
Develops and maintains strong relationships with clinical client champions.
Collaborates with all EvidenceCare verticals in the fulfillment of client optimization requests while maintaining integrity in standards related to regulatory and clinical best practices.
Builds professional skills by maintaining awareness of the healthcare environment, clinical information systems technology, evidence-based practice, leadership and informatics industry trends and standards.
Performs additional duties as assigned by EvidenceCare leadership as assigned.