UR Clinical Operations Lead

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    "id": "37",
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      "city": "SHORT HILLS",
      "state": "New Jersey",
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    "jobOpeningName": "UR Clinical Operations Lead",
    "departmentLabel": "CUR",
    "employmentStatusLabel": "Full-Time"
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    "datePosted": "2026-06-18",
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      "city": "SHORT HILLS",
      "state": "New Jersey",
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    "description": "<p><span style=\"font-weight: bold\">Position Summary</span><br></p>\n<p>The Utilization Review (UR) Clinical lead serves as a subject matter expert in utilization management and hospital revenue cycle operations. This role partners directly with large hospital systems to assess, optimize, and support utilization review and denial management initiatives.</p>\n<p>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. This position requires a consultative mindset, excellent communication skills, and the ability to influence change while driving measurable outcomes for clients.</p>\n<p><br></p>\n<p><span style=\"font-weight: bold\">Essential Responsibilities</span></p>\n<ul>\n<li>Serve as the primary clinical consultant for assigned hospital and health system clients.</li>\n<li>Build and maintain strong relationships with client leadership, including Case Management Directors, Revenue Cycle Leaders, Physician Advisors, and C-suite executives.</li>\n<li>Conduct assessments of utilization review processes and identify opportunities for operational improvement.</li>\n<li>Provide strategic recommendations to improve authorization processes, reduce denials, and optimize reimbursement.</li>\n<li>Facilitate client meetings, present findings, and communicate project updates to stakeholders.</li>\n<li>Support implementation of process improvements and monitor performance metrics.</li>\n<li>Review inpatient and outpatient utilization management processes for compliance and efficiency.</li>\n<li>Analyze denial trends, payer behavior, and utilization patterns.</li>\n<li>Collaborate with physician advisors and operational teams to improve medical necessity documentation and appeal success rates.</li>\n<li>Provide guidance on CMS, Medicare, Medicaid, and commercial payer requirements.</li>\n<li>Assist clients with length-of-stay management, authorization processes, and denial prevention strategies.</li>\n<li>Develop and implement best practices related to utilization management and revenue integrity.</li>\n<li>Educate client teams on regulatory changes, payer requirements, and industry best practices.</li>\n<li>Develop training materials, workflows, and standard operating procedures.</li>\n<li>Mentor and support internal consultants and clinical team members.</li>\n<li>Serve as a subject matter expert during client engagements and business development opportunities.</li>\n</ul>\n<p><br><br></p>\n<p><span style=\"font-weight: bold\">Experience</span></p>\n<ul>\n<li>Minimum of 7 years of Utilization Review, Case Management or Revenue Cycle experience.</li>\n<li>Minimum of 3 years working directly with hospital systems in a consulting or client-facing capacity.</li>\n<li>Strong understanding of:\n<ul>\n<li>Hospital revenue cycle operations</li>\n<li>Utilization management</li>\n<li>Denial management</li>\n<li>Medical necessity criteria</li>\n<li>Payer regulations and reimbursement methodologies</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Experience presenting in executive leadership and facilitating client meetings.</li>\n</ul>\n</li>\n</ul>\n<p><br><br></p>\n<p><span style=\"font-weight: bold\">Knowledge &amp; Skills</span></p>\n<ul>\n<li>Strong knowledge of Medicare, Medicaid, and commercial payer requirements.</li>\n<li>Experience with electronic medical records, preferably Epic.</li>\n<li>Excellent presentation and communication skills.</li>\n<li>Ability to build credibility and influence stakeholders at all levels.</li>\n<li>Strong analytical and problem-solving abilities.</li>\n<li>Self-directed with the ability to manage multiple client engagements simultaneously.</li>\n<li>Proficiency in Microsoft Office applications, particularly Excel and PowerPoint.</li>\n</ul>\n<p> </p>\n<p><span style=\"font-weight: bold\">Qualifications</span></p>\n<p><span style=\"font-weight: bold\">Education</span></p>\n<ul>\n<li>Registered Nurse (RN) required; BSN preferred.</li>\n<li>Advanced degree (MSN, MHA, MBA) preferred.</li>\n</ul>\n<p><br><br></p>\n<p><span style=\"font-weight: bold\">Licensure</span></p>\n<ul>\n<li>Active, unrestricted RN license required.</li>\n</ul>\n<p><span style=\"font-weight: bold\">Travel Requirements</span></p>\n<ul>\n<li>Up to 25% travel, as required by client engagements.</li>\n</ul>",
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    "jobOpeningName": "UR Clinical Operations Lead",
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    "minimumExperience": "Experienced",
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