Clinical Operations Lead

🔥 0 minutes ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

⏰ Full Time

🟠 Senior

🏥 Clinical Operations

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

HURC Healthcare Solutions

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2018

🤝 B2B

⚕️ Healthcare Insurance

🎯 Recruiter

B2B • Healthcare Insurance • Recruitment

HURC Healthcare Solutions is a B2B healthcare services firm that partners with hospitals and provider organizations to manage utilization review, clinical revenue cycle operations, and population health outreach. The company provides centralized Utilization Review (CŪR), revenue cycle management that combines domestic oversight with offshore resources, and staff augmentation and automation services to maximize net patient revenue and reduce operational burdens. HURC emphasizes people-powered, customizable services that integrate with clients' existing systems and bridge the payer-provider gap so clinicians can focus on patient care.

📋 Description

• Serve as the primary clinical consultant for assigned hospital and health system clients. • Build and maintain strong relationships with client leadership, including Case Management Directors, Revenue Cycle Leaders, Physician Advisors, and C-suite executives. • Conduct assessments of utilization review processes and identify opportunities for operational improvement. • Provide strategic recommendations to improve authorization processes, reduce denials, and optimize reimbursement. • Facilitate client meetings, present findings, and communicate project updates to stakeholders. • Support implementation of process improvements and monitor performance metrics. • Review inpatient and outpatient utilization management processes for compliance and efficiency. • Analyze denial trends, payer behavior, and utilization patterns. • Collaborate with physician advisors and operational teams to improve medical necessity documentation and appeal success rates. • Provide guidance on CMS, Medicare, Medicaid, and commercial payer requirements. • Assist clients with length-of-stay management, authorization processes, and denial prevention strategies. • Develop and implement best practices related to utilization management and revenue integrity. • Educate client teams on regulatory changes, payer requirements, and industry best practices. • Develop training materials, workflows, and standard operating procedures. • Mentor and support internal consultants and clinical team members. • Serve as a subject matter expert during client engagements and business development opportunities.

🎯 Requirements

• Minimum of 7 years of Utilization Review, Case Management or Revenue Cycle experience. • Minimum of 3 years working directly with hospital systems in a consulting or client-facing capacity. • Strong understanding of: Hospital revenue cycle operations, Utilization management, Denial management, Medical necessity criteria, Payer regulations and reimbursement methodologies. • Experience presenting in executive leadership and facilitating client meetings. • Strong knowledge of Medicare, Medicaid, and commercial payer requirements. • Experience with electronic medical records, preferably Epic. • Excellent presentation and communication skills. • Ability to build credibility and influence stakeholders at all levels. • Strong analytical and problem-solving abilities. • Self-directed with the ability to manage multiple client engagements simultaneously. • Proficiency in Microsoft Office applications, particularly Excel and PowerPoint.

🏖️ Benefits

• Up to 25% travel, as required by client engagements.