hurc
UR Clinical Operations Lead
SHORT HILLS, New Jersey, United States
Sponsorship not specifiedDetected 20 days ago
Business DevelopmentExcelEHR/EMRLeadershipCommunicationProblem SolvingPublic SpeakingMicrosoft Office
About the role
- The ideal candidate is a licensed clinician with strong utilization review experience and the ability to work directly with executive and operational leaders within healthcare organizations.
- Serve as the primary clinical consultant for assigned hospital and health system clients.
Responsibilities
- This role partners directly with large hospital systems to assess, optimize, and support utilization review and denial management initiatives.
- Build and maintain strong relationships with client leadership, including Case Management Directors, Revenue Cycle Leaders, Physician Advisors, and C-suite executives.
- Support implementation of process improvements and monitor performance metrics.
- Develop and implement best practices related to utilization management and revenue integrity.
- Develop training materials, workflows, and standard operating procedures.
- Mentor and support internal consultants and clinical team members.
- The Utilization Review (UR) Clinical lead serves as a subject matter expert in utilization management and hospital revenue cycle operations.
Requirements
- Active, unrestricted RN license required.
- Up to 25% travel, as required by client engagements.
- This position requires a consultative mindset, excellent communication skills, and the ability to influence change while driving measurable outcomes for clients.
- 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.
- Education
- BSN preferred.
- Advanced degree (MSN, MHA, MBA) preferred.
- Licensure
- Travel Requirements
Nice to have
- Hospital revenue cycle operations
- Utilization management
- Denial management
- Experience presenting in executive leadership and facilitating client meetings.
- Knowledge & Skills
- Strong knowledge of Medicare, Medicaid, and commercial payer requirements.
- Excellent presentation and communication skills.
- Strong analytical and problem-solving abilities.
Benefits
- Provide strategic recommendations to improve authorization processes, reduce denials, and optimize reimbursement.
- Collaborate with physician advisors and operational teams to improve medical necessity documentation and appeal success rates.
This listing is sourced directly from hurc's careers page and normalized into a canonical job model.