Sr Director of Patient Access and Utilization Management

Director of Patient AccessNashville General Hospital is hiring a Director of Patient Access for full-time DayThe Director of Patient Access reports to the Chief Revenue Cycle and has oversight responsibility of all patient admission, registration and associated activities including scheduling, pre-registration, insurance verification, registration, bed assignment and discharge. Also, responsible for the maintenance and integrity of the registration systems and related data and statistics.Primary Duties and ResponsibilitiesLeadership & Oversight:Responsible for planning, organizing, and directing the overall operations of Patient Access and Utilization Management.Oversee scheduling, registration, financial counseling, insurance verification, and admissions.Direct, implement, and integrate all PA functions including: Scheduling, Financial Counseling and Financial Clearance, Pre-registration and Registration.Ensure timely and accurate patient registration processes and optimal revenue cycle outcomes Direct, implement, and integrate all UM functions including: Denials Management, Peer-to-Peer Reviews, Concurrent and retrospective utilization reviews.Lead and direct the coordination and facilitation of accurate patient status identification.Oversee and evaluate the effectiveness of the utilization management program, recommending improvements and implementing best practices.Develop and execute an interdisciplinary Utilization Review Committee with consistent physician participation and oversight.Maintain compliance with NCQA and Joint Commission standards across all related functions.Evaluate Patient Access and Utilization Management program targets and outcomes for all payer types, ensuring alignment with annual operating plan, state mandates, and financial goals.Financial & Operational ManagementDevelop and implement inventory and cost accounting policies, procedures, and operational reporting.Review and interpret reports and trends to support financial forecasting and strategic planning.Monitor, evaluate, and report on departmental performance to senior leadership.Quality, Risk, and ComplianceIdentify and resolve quality and risk management issues, supporting continuous performance improvement and reporting.Ensure compliance with: Federal, State, and Local regulations, Joint Commission and CMS standards, NCQA standards for utilization review.Develop and implement departmental policies and procedures to increase efficiency, effectiveness, and regulatory compliance.Risk, Auditing & InvestigationsProvide strategic oversight for billing and coding compliance, working closely with the Revenue Cycle and Finance departments to ensure adherence to all federal and state billing regulations.Collaborate with executive leadership on the organization's Enterprise Risk Management (ERM) program, ensuring that compliance risks are effectively identified, assessed, and mitigated.Direct and oversee a comprehensive auditing and monitoring program to identify and address potential areas of compliance risk.Develop and manage a confidential reporting system (e.g., compliance hotline) and oversee the investigation of all reported compliance concerns in a timely and effective manner.Develop and implement initial and ongoing compliance training programs for all employees, medical staff, and board members.Community & Academic PartnershipLead and oversee the hospital's contract management process, ensuring all agreements are properly vetted for compliance, risk, and accuracy.Implement and maintain a centralized system for contract review, approval, and storage to mitigate organizational risk.Required Skills & QualificationsBachelors degree in Nursing, Healthcare Administration, Business or related field required. Master's degree in Healthcare Administration (MHA), Business Administration (MBA), or a related advanced degree.This senior director position requires a minimum of 10 years of progressive administrative and supervisory experience; a minimum of (8) years' experience in a healthcare management position preferred. Will demonstrate ability to handle multiple projects simultaneously and proficiency in budgeting and negotiation skills. Demonstrate verbal and written communication skills. Functional knowledge of computers and basic PC application programs including word processing and spreadsheets; experience with the HIS Affinity system preferred. Thorough knowledge of hospital patient access and utilization management functions, knowledge of medical terminology. Detailed knowledge of current Joint Commission, state and federal requirements. Working knowledge in the fundamentals of financial analysis, basic credit principles, and collection methods. Demonstrated skill in independently identifying workflow, patient flow, personnel and procedural problems and implementing viable solutions. Working knowledge in the insurance verification and interpretation of coverage. Demonstrated knowledge of Word, Excel and basic knowledge of hospital computer system. Works well with others and collaborates with departmental and hospital- wide teams to achieve common goals. Demonstrated ability to reach and/or make decisions, to take appropriate actions and follow-through within scope of responsibility. Self-motivated to meet or exceed deadlines based on shifting priorities.Core CompetenciesFinancial and Revenue Cycle Acumen: A deep understanding of revenue cycle management and financial principles to optimize reimbursement, manage budgets, and reduce claim denials.Operational and Technical Expertise: The ability to oversee and improve patient access and utilization management workflows, leveraging technology and data analytics to enhance efficiency and patient satisfaction.Regulatory and Compliance Knowledge: An in-depth understanding of healthcare laws, payer-specific regulations, and compliance standards to ensure all operations are ethical and legally sound.Strategic Planning and Leadership: The capacity to develop and execute long-term strategies, lead teams through change, and drive continuous improvement across the department.Collaborative Communication: The skill to build strong relationships and effectively communicate with diverse stakeholders, including physicians, senior leadership, and insurance payers.About Nashville General HospitalNashville General Hospital (NGH) is Nashville's original community-based hospital. Joint Commission accredited, NGH readily accommodates a wide range of needs from emergency services and acute care to ancillary and ambulatory services. NGH continues to maintain its strong commitment to the healthcare needs of Nashville and Davidson County underserved, while also providing care to all segments of the community.Our Benefits Include:Medical, Dental, and Vision Insurance within first 31 days of employmentPrograms to reduce share of deductible and total out-of-pocket expensesMetro Health Incentive Program - Access to high quality healthcare without incurring out-of-pocket expensesShort and Long-Term Disability - up to 60% of eligible weekly payLife Insurance - Metro provides you with basic life and AD&D coverage equal to $50,000 ($32,500 if you are age 65 or older), at no cost to you.Retirement Plan - eligible up to IRS max limits and includes company contributionShift and Weekend Differential Pay Offered on Nights and WeekendsTuition Reimbursement for employee and dependents12 paid holidays - any holiday worked is another holiday bankedFlexible Spending AccountsFree Parking for all employeesNashville General Hospital is an Equal Opportunity Employer/Disability/Veteran. We are an E-Verify employer.