Sr Director of Patient Access and Utilization Management

Nashville General Hospital • Nashville, TN

106d

About The Position

Nashville General Hospital is hiring a Director of Patient Access for full-time Day! The Director of Patient Access reports to the Chief Revenue Cycle and has oversight responsibility of all patient admission, registration and associated activities including scheduling, pre-registration, insurance verification, registration, bed assignment and discharge. Also, responsible for the maintenance and integrity of the registration systems and related data and statistics.

Requirements

• Bachelors degree in Nursing, Healthcare Administration, Business or related field required.
• Master’s degree in Healthcare Administration (MHA), Business Administration (MBA), or a related advanced degree.
• Minimum of 10 years of progressive administrative and supervisory experience.
• Minimum of 8 years’ experience in a healthcare management position preferred.
• Ability to handle multiple projects simultaneously and proficiency in budgeting and negotiation skills.
• Demonstrate verbal and written communication skills.
• Functional knowledge of computers and basic PC application programs including word processing and spreadsheets; experience with the HIS Affinity system preferred.
• Thorough knowledge of hospital patient access and utilization management functions, knowledge of medical terminology.
• Detailed knowledge of current Joint Commission, state and federal requirements.
• Working knowledge in the fundamentals of financial analysis, basic credit principles, and collection methods.
• Demonstrated skill in independently identifying workflow, patient flow, personnel and procedural problems and implementing viable solutions.
• Working knowledge in the insurance verification and interpretation of coverage.
• Demonstrated knowledge of Word, Excel and basic knowledge of hospital computer system.
• Works well with others and collaborates with departmental and hospital-wide teams to achieve common goals.
• Demonstrated ability to reach and/or make decisions, to take appropriate actions and follow-through within scope of responsibility.
• Self-motivated to meet or exceed deadlines based on shifting priorities.

Nice To Haves

• Financial and Revenue Cycle Acumen: A deep understanding of revenue cycle management and financial principles to optimize reimbursement, manage budgets, and reduce claim denials.
• Operational and Technical Expertise: The ability to oversee and improve patient access and utilization management workflows, leveraging technology and data analytics to enhance efficiency and patient satisfaction.
• Regulatory and Compliance Knowledge: An in-depth understanding of healthcare laws, payer-specific regulations, and compliance standards to ensure all operations are ethical and legally sound.
• Strategic Planning and Leadership: The capacity to develop and execute long-term strategies, lead teams through change, and drive continuous improvement across the department.
• Collaborative Communication: The skill to build strong relationships and effectively communicate with diverse stakeholders, including physicians, senior leadership, and insurance payers.

Responsibilities

• Responsible for planning, organizing, and directing the overall operations of Patient Access and Utilization Management.
• Oversee scheduling, registration, financial counseling, insurance verification, and admissions.
• Direct, implement, and integrate all PA functions including Scheduling, Financial Counseling and Financial Clearance, Pre-registration and Registration.
• Ensure timely and accurate patient registration processes and optimal revenue cycle outcomes.
• Direct, implement, and integrate all UM functions including Denials Management, Peer-to-Peer Reviews, Concurrent and retrospective utilization reviews.
• Lead and direct the coordination and facilitation of accurate patient status identification.
• Oversee and evaluate the effectiveness of the utilization management program, recommending improvements and implementing best practices.
• Develop and execute an interdisciplinary Utilization Review Committee with consistent physician participation and oversight.
• Maintain compliance with NCQA and Joint Commission standards across all related functions.
• Evaluate Patient Access and Utilization Management program targets and outcomes for all payer types, ensuring alignment with annual operating plan, state mandates, and financial goals.
• Develop and implement inventory and cost accounting policies, procedures, and operational reporting.
• Review and interpret reports and trends to support financial forecasting and strategic planning.
• Monitor, evaluate, and report on departmental performance to senior leadership.
• Identify and resolve quality and risk management issues, supporting continuous performance improvement and reporting.
• Ensure compliance with Federal, State, and Local regulations, Joint Commission and CMS standards, and NCQA standards for utilization review.
• Develop and implement departmental policies and procedures to increase efficiency, effectiveness, and regulatory compliance.
• Provide strategic oversight for billing and coding compliance, working closely with the Revenue Cycle and Finance departments.
• Collaborate with executive leadership on the organization's Enterprise Risk Management (ERM) program.
• Direct and oversee a comprehensive auditing and monitoring program to identify and address potential areas of compliance risk.
• Develop and manage a confidential reporting system and oversee the investigation of all reported compliance concerns.
• Develop and implement initial and ongoing compliance training programs for all employees, medical staff, and board members.
• Lead and oversee the hospital's contract management process, ensuring all agreements are properly vetted for compliance, risk, and accuracy.

Benefits

• Medical, Dental, and Vision Insurance within first 31 days of employment.
• Programs to reduce share of deductible and total out-of-pocket expenses.
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Master's degree
• Number of Employees: 501-1,000 employees