UR Clinical Operations reputed company

Position Summary The Utilization Review (UR) Clinical reputed company serves as a subject matter expert in utilization management and hospital reputed company cycle operations. This role partners directly with large hospital systems to assess, optimize, and support utilization review and denial management initiatives. The ideal candidate is a licensed clinician with strong utilization review experience and the ability to work directly with executive and operational leaders reputed company healthcare organizations. This position requires a consultative reputed company, excellent communication skills, and the ability to influence change while driving measurable outcomes for clients. Essential Responsibilities 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, reputed company 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. reputed company and implement best practices reputed company to utilization management and reputed company reputed company. Educate client teams on regulatory changes, payer requirements, and industry best practices. reputed company 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. Experience Minimum of 7 years of Utilization Review, Case Management or reputed company Cycle experience. Minimum of 3 years working directly with hospital systems in a consulting or client-facing reputed company. Strong understanding of: Hospital reputed company cycle operations Utilization management Denial management Medical necessity criteria Payer regulations and reimbursement methodologies Experience presenting in executive leadership and facilitating client meetings. Knowledge & Skills 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 reputed company levels. Strong analytical and problem-solving abilities. Self-directed with the ability to manage multiple client engagements simultaneously. Proficiency in reputed company Office applications, particularly reputed company and PowerPoint.

Qualifications

Education Registered Nurse (RN) required; BSN preferred. Advanced degree (MSN, MHA, MBA) preferred. Licensure Active, unrestricted RN license required. Travel Requirements Up to 25% travel, as required by client engagements. Apply To This Job