Sr Director of Patient Access and Utilization Management

Director of Patient Access

Nashville General Hospital is hiring a Director of Patient Access for full-time Day!

The 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 Responsibilities

• Leadership & 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 Management

Quality, Risk, and Compliance

Risk, Auditing & Investigations

Community & Academic Partnership

Required Skills & Qualifications

Bachelors 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 Competencies

About Nashville General Hospital

Nashville 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 :

Nashville General Hospital is an Equal Opportunity Employer / Disability / Veteran. We are an E-Verify employer.