Clinical Services Manager | ASAP
1 week ago
Qualifications Minimum of 5+ years of combined experience in direct patient care and/or a clinical administrator role (e.g., utilization management, clinical authorizations, clinical denials, or clinical documentation integrity) with a solid track record in reputable organizations. Registered Nurse (RN) or hold another clinical patient care designation. BS/BA required ; a graduate degree in health, medicine, or nursing is preferred. Exposure to U.S. revenue cycle processes is a strong plus. Experience & Education Minimum of 5+ years of combined experience in direct patient care and/or a clinical administrator role (e.g., utilization management, clinical authorizations, clinical denials, or clinical documentation integrity) with a solid track record in reputable organizations. Industry Knowledge Comprehensive understanding of the U.S. healthcare industry, including both payor and provider ecosystems and their interrelationships. Familiarity with clinical RCM vendors, services, trends, market disruptions, and key differentiators. Technical Expertise Hands-on experience with revenue cycle-related technology within the clinical revenue cycle, such as computer-assisted CDI, auditing, utilization management review, and clinical appeal automation. Global Perspective Preferred: At least 2+ years of experience working in or with global RCM business process outsourcing (BPO) delivery models. Continuous Learning Strong ability to learn and synthesize new information quickly. Demonstrates intellectual curiosity and stays current on industry trends to help shape solution frameworks and intellectual property for the service line. Jobs-to-Be-Done Serve as Clinical Subject Matter Expert (SME) Strategic Support: Collaborate with the VP of Coding and Clinical Service Line to drive operational excellence and execute the organizations strategy for relevant service lines. Go-to-Market Support: Communicate effectively internally and externally with strong clinical domain expertise. Contribute to thought leadership by researching and developing market-facing content such as white papers, case studies, marketing collateral, clinical website sections, and webinar materials. Ensure all content reflects current industry-leading practices and delivery models. Clinical Analytics: Identify and collect key performance indicators (KPIs) for clinical service lines. Analyze project data to generate insights on production, quality, and outcomes for internal performance tracking and external reporting. Education & Training: Partner with the Director of Clinical Education to design and update clinical training programs. Work collaboratively with internal teams (Talent Development, Operations, etc.) to ensure a comprehensive training approach that reflects industry trends and regulatory requirements. Support Strategic Development Assist in refining, developing, and implementing the companys Clinical Solutions strategy in alignment with the organizations long-term (5+ year) strategic goals. Drive Clinical Initiatives Provide support for other clinical service line initiatives as assigned, contributing to continuous improvement and innovation. #J-18808-Ljbffr
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