AVP, Utilization Management

🕒 Junho 3

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Ensemble Health Partners

SiteLinkedInTodas as Vagas

5001 - 10000 funcionários

⚕️ Seguro de Saúde

☁️ SaaS

🏢 Corporativo

💰 Private Equity Round em 2022-03

Healthcare Insurance • SaaS • Enterprise

A Ensemble Health Partners é uma das principais fornecedoras de serviços de gestão do ciclo de receita (RCM) para organizações de saúde. Eles oferecem uma solução RCM completa que ajuda hospitais, sistemas de saúde e grupos de médicos afiliados a otimizar seus ciclos de receita, reduzir recusas e pagamentos incorretos, e melhorar as experiências dos pacientes usando uma combinação de gestão especializada e tecnologia avançada. A Ensemble Health Partners utiliza operadores certificados e inteligência artificial para entregar resultados consistentes, melhorar as cobranças e apoiar o crescimento futuro dos provedores de saúde. Eles são reconhecidos por suas parcerias robustas com clientes e pelo compromisso em proporcionar aumento confiável de receita e economia de custos para seus clientes.

Descrição

• Executes enterprise utilization management strategy aligned with organizational and regulatory requirements • Oversees operations including prior authorization, medical necessity review, and concurrent review processes • Ensures compliance with CMS, payer, and state regulatory requirements • Identifies and mitigates audit, compliance, and reimbursement risks • Monitors performance metrics including denial trends and utilization efficiency • Drives performance improvement initiatives based on data analysis • Collaborates with clinical, case management, and revenue cycle teams to improve documentation and reduce denials • Supports implementation and optimization of utilization management technologies and workflows • Leads and develops managers and operational leaders • Supports succession planning and organizational capability development • May be required to perform other job-related duties as requested.

🎯 Requisitos

• Bachelor’s degree or equivalent combination of education and experience • Current RN license • 10+ years of relevant experience including advanced knowledge of utilization management and healthcare reimbursement • 5+ years of people leadership experience • Strong executive presence with the ability to project confidence, credibility and authority; able to remain calm & show decisiveness under pressure • Exhibits strong strategic and analytical skills with the ability to drive operational improvements • Ability to build and maintain relationships with key internal and external stakeholders • Ability to effectively lead diverse teams and influence change management in a complex healthcare operations environment • Effective communication skills with ability to clearly and succinctly convey information and ideas • Demonstrated advanced usage of AI, success in translating AI into Business outcomes, and the ability to move teams from experimentation to scale.

🏖️ Benefícios

• Health insurance • Time off • Retirement plans • Well-being programs • Professional development opportunities