Sr Director of Patient Access and Utilization Management

Nashville General Hospital-posted 3 days ago
Full-time • Director
Nashville, TN
501-1,000 employees
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Nashville General Hospital is hiring a Sr. Director of Patient Access and Utilization Management. Join our leadership team and make a lasting impact on patient care! We are seeking an experienced and visionary Senior Director to lead our Patient Access and Utilization Management functions. In this key role, you will oversee registration, financial clearance, insurance verification, and utilization review programs, ensuring seamless patient flow and optimal revenue cycle performance. If you are a strategic thinker with a passion for improving processes, leading high-performing teams, and driving compliance with state, federal, and accreditation standards we want to hear from you! About Nashville General Hospital Nashville General Hospital (NGH) is Nashville’s original community-based hospital. Joint Commission accredited, NGH readily accommodates a wide range of needs from emergency services and acute care to ancillary and ambulatory services. NGH continues to maintain its strong commitment to the healthcare needs of Nashville and Davidson County underserved, while also providing care to all segments of the community

  • Plan, organize, and direct the overall operations of Patient Access (PA) and Utilization Management (UM).
  • Oversee scheduling, registration, insurance verification, financial counseling, and admissions functions.
  • Direct, implement, and integrate PA functions (scheduling, financial clearance, registration) and UM functions (denials management, peer-to-peer reviews, concurrent/retrospective reviews).
  • Ensure accurate patient status identification and optimal revenue cycle outcomes.
  • Develop and lead the Utilization Review Committee with consistent physician participation.
  • Maintain compliance with NCQA, Joint Commission, CMS, and state regulations.
  • Develop inventory and cost accounting policies and reporting.
  • Analyze departmental performance trends to support forecasting and strategic planning.
  • Present performance outcomes and improvement initiatives to senior leadership.
  • Identify and resolve quality and risk issues.
  • Develop and implement policies and procedures to increase efficiency and compliance.
  • Ensure compliance with federal, state, and local regulations, as well as NCQA and Joint Commission standards.
  • Provide strategic oversight for billing and coding compliance.
  • Partner with executive leadership on Enterprise Risk Management (ERM) to mitigate compliance risks.
  • Lead comprehensive auditing and monitoring programs.
  • Manage confidential reporting systems and investigate compliance concerns.
  • Design and deliver compliance training for staff, medical providers, and board members.
  • Lead and oversee contract management, including review, approval, and storage.
  • Mitigate risk by maintaining a centralized, compliant contract management system.
  • Bachelor’s - Nursing, Business Administration, Healthcare Administration, or related field (Required)
  • Master’s in Healthcare Administration (MHA), Business Administration (MBA), or related advanced degree (Required)
  • Minimum 10 years of progressive administrative and supervisory experience
  • Minimum 8 years in a healthcare management position (preferred)
  • Proven ability to handle multiple projects simultaneously with strong budgeting and negotiation skills
  • Functional knowledge of computers, word processing, spreadsheets, and hospital information systems (HIS Affinity preferred)
  • Thorough knowledge of patient access, utilization management, and medical terminology
  • Detailed knowledge of Joint Commission, NCQA, CMS, state, and federal requirements
  • Experience with insurance verification, coverage interpretation, and revenue cycle optimization
  • Strong verbal and written communication skills with a proven ability to collaborate with hospital-wide teams
  • Demonstrated ability to independently identify problems, implement solutions, and meet deadlines
  • Medical, Dental, and Vision Insurance within first 31 days of employment
  • Metro Health Incentive Program - Access to high quality healthcare without incurring out-of-pocket expenses
  • Short and Long-Term Disability - up to 60% of eligible weekly pay
  • Life Insurance - Metro provides you with basic life and AD&D coverage equal to $50,000 ($32,500 if you are age 65 or older), at no cost to you.
  • Retirement Plan - eligible up to IRS max limits and includes company contribution
  • Shift and Weekend Differential Pay Offered on Nights and Weekends
  • Tuition Reimbursement for employee and dependents
  • 12 paid holidays - any holiday worked is another holiday banked
  • Flexible Spending Accounts
  • Free Parking for all employees
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