Director of Clinical Operations

Interested in using your Care Management leadership experience and skills in a remote, office-based environment?  Interested in joining a fast-growing company with a great work environment, that delivers exemplary clinical services to our hospital clients? Is team building and a healthy, fun culture important to you?   We are looking for an experienced RN Case Management leader who is hyper-focused on delivering consistent, superb results to our clients. Our clinical services encompass all of the typical aspects of clinical care management including virtual, concurrent utilization review, clinical appeals, government audit (RAC) resolution, precertification, retrospective Medicaid reviews status post eligibility and other clinical solutions that differentiate us in the market place.  Qualified candidates must be able to demonstrate a proven track record of delivering and communicating results on key process indicators of the aforementioned.  You will focus on the development, performance and growth of your team and the organization as a whole.  Our comprehensive benefit package is competitive; including but not limited to, paid time off, health, life and disability insurance, gym membership, and a 401K retirement savings plan with an employer match after one year of service. 

Qualifications:

• Must possess current RN license, BSN preferred
• 5 Years of Clinical Case Management/Utilization Review/Appeals (Payer or Hospital environment) experience with at least 3 years of leadership experience including hiring qualified nurses
• Proven and demonstrated success as a leader in the Payer or Hospital environment with excellent written and verbal communication skills
• Possesses a deep knowledge of medical necessity criteria including MCG and/or InterQual, both preferred; adept at applying said criteria sets
• Experience in defending government audits such as RAC and medical necessity appeals by writing compelling, persuasive, clinically fact-based letters
• Ability to work across multiple disciplines/departments to achieve results
• Strong understanding of how Case Management and Revenue Integrity (HIM) impact the hospital revenue cycle
• Demonstrated mathematical / analytical aptitude with the ability to translate operational concepts into measurable results; ability to consistently deliver strong results
• Experience working in multiple EMR/Patient accounting environments, Case Management documentation platforms and adjunct systems
• Action-oriented, results-oriented, "take charge" attitude, capable of developing a strong business case for client or company actions
• Ability to become a trusted partner to our clients and colleagues while anticipating their needs
• Ability to quickly recognize, develop and execute process efficiencies while measuring impact of such efficiencies
• Ability to interact at the executive level with our clients and colleagues relative to all forms of communication