Operations Program Manager

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

🔴 Lead

📋 Program Manager

👻 Ghost score 25%

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Outsourcey

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2024

🤝 B2B

🛍️ eCommerce

B2B • eCommerce • IT outsourcing

Outsourcey is a leading remote staffing agency specializing in connecting businesses with skilled offshore talent. They simplify the outsourcing process for companies ranging from startups to Fortune 500 firms, offering flexible staffing solutions without long-term contracts or setup fees. By leveraging a vast network of qualified professionals, Outsourcey helps clients reduce operational costs while improving efficiency and scalability, ensuring that businesses can effectively meet their project demands across various industries.

📋 Description

• Develop and execute the strategic roadmap for clinical denial management programs • Establish program goals, KPIs, governance structures, and performance standards • Oversee multiple teams, managers, and/or client programs • Align clinical denial strategy with organizational revenue cycle objectives • Develop standardized operating models, workflows, and best practices • Own program-level denial recovery and financial performance • Monitor gross and net revenue opportunity, dollars at risk, recovery rate, overturn rate, and denial inventory • Develop strategies to maximize reimbursement and reduce revenue leakage • Support financial forecasting, business cases, and resource planning • Identify opportunities for automation, technology, and workflow optimization • Provide subject-matter leadership for complex clinical denial categories • Establish enterprise strategies for medical necessity, DRG, level-of-care, clinical validation, documentation, and payer-specific denials • Review emerging payer policies and reimbursement changes • Develop strategies for high-value and systemic denial issues • Partner with clinical and revenue cycle leadership to address root causes • Serve as senior operational contact for assigned clients and programs • Lead executive-level business reviews and performance discussions • Present program performance, financial outcomes, trends, risks, and strategic recommendations • Manage client expectations and escalations • Identify opportunities for program expansion and additional value creation • Lead enterprise-wide denial prevention initiatives • Use data analytics to identify systemic denial drivers • Partner with CDI, HIM, coding, utilization management, clinical operations, finance, and billing leadership • Develop corrective action and prevention strategies • Measure the financial and operational impact of prevention initiatives • Lead transformation projects involving technology, analytics, automation, and workflow redesign • Provide leadership to Managers, Team Leads, and clinical denial professionals, with a team size of minimum 50+ • Establish leadership development and succession-planning strategies • Promote a culture of accountability, continuous improvement, and client service • Ensure appropriate staffing models and organizational structures • Oversee competency and training programs • Ensure programs operate in accordance with regulatory requirements, payer policies, contractual obligations, and organizational standards • Monitor emerging regulatory and reimbursement changes • Identify operational and financial risks and develop mitigation strategies

🎯 Requirements

• Bachelor’s degree in nursing, Healthcare Administration, Health Information Management, or related field • Active RN license or applicable clinical credential • 7+ years of healthcare experience, with substantial experience in clinical denials, CDI, RCM, utilization management, appeals, or reimbursement • 3+ years of progressive leadership/management experience • Demonstrated experience managing large-scale programs, multiple teams, or complex client engagements • Strong understanding of inpatient DRG, medical necessity, level of care, clinical validation, coding, reimbursement, and payer policies • Demonstrated financial and analytical acumen • Excellent executive communication, presentation, negotiation, and stakeholder-management skills • Preferred: CDAS or equivalent denial management credential • Preferred: CCDS/CDIP or equivalent CDI certification • Preferred: Master’s degree such as MHA, MBA, MSN, or related discipline • Preferred: Experience with enterprise RCM transformation • Preferred: Experience with Epic, payer portals, denial analytics, and business intelligence platforms • Preferred: Experience managing multi-hospital or multi-client programs • Preferred: Experience with automation, AI, analytics, or technology-enabled denial management

🏖️ Benefits

• Competitive salary • Opportunity to shape the HR function of a rapidly growing BPO • Work closely with a team of industry leaders who have successfully scaled BPOs in the past • Career growth and development opportunities