Manager, Clinical Bill Review

📋 Description

• Take ownership and lead the clinical bill review function, establishing strategic direction that aligns with organizational goals, client expectations, and growth priorities.

• Manage and enhance the contract lifecycle management (CLM) system, ensuring data integrity, governance, and scalability to support operational and financial outcomes.

• Develop and refine performance management frameworks, including KPIs, productivity standards, and quality benchmarks that foster accountability and continuous improvement.

• Promote program effectiveness and scalability by assessing operational performance and implementing initiatives that improve consistency, efficiency, and financial impact.

• Direct workforce strategy, encompassing capacity planning, organizational design, and resource allocation to meet both current and future business demands.

• Oversee end-to-end operational performance, focusing on quality, turnaround times, savings outcomes, and overall excellence in service delivery.

• Utilize data and analytics to detect trends, identify systemic gaps, and uncover optimization opportunities, converting insights into actionable strategies.

• Advocate for operational excellence initiatives that minimize rework, boost throughput, and enhance overall efficiency throughout the clinical review lifecycle.

• Provide direct leadership and accountability for team performance, cultivating a high-performance culture and ensuring alignment with established standards and goals.

• Design and manage quality assurance frameworks, which include audit methodologies, review standards, and continuous feedback mechanisms.

• Ensure adherence to client plan documents, regulatory requirements, and internal policies, proactively identifying and addressing risks.

• Recognize and mitigate enterprise-level risks, implementing controls and escalation pathways to safeguard organizational and client interests.

• Offer executive-level oversight on complex, high-risk, or escalated determinations, ensuring consistency and defensibility in decision-making.

• Enhance the financial performance of the clinical bill review program, focusing on savings optimization and value delivery to clients.

• Create and present executive reporting and insights, communicating performance, risks, and opportunities to senior leadership and key stakeholders.

• Identify and spearhead opportunities for revenue growth, cost reduction, and program expansion, contributing to the broader business strategy.

• Act as a subject matter expert and strategic partner, supporting pricing, client engagements, and growth initiatives within the organization.

• Collaborate cross-functionally with Product, Technology, Compliance, and Client teams to develop tools, workflows, and solutions that enhance outcomes and client value.

• Influence system strategy and process design, driving improvements that facilitate scalability, standardization, and automation across the function.

• Serve as a senior escalation point for complex client and provider issues, ensuring timely resolution while maintaining relationships and organizational integrity.

• Represent the clinical bill review function in enterprise initiatives and strategic planning efforts, ensuring alignment with broader organizational priorities.

• Lead and participate in special projects and evolving business needs, showcasing adaptability and ownership beyond core responsibilities.

⛳️ Requirements

• A minimum of 8 years of experience in clinical bill review, utilization review, medical cost containment, or a related healthcare/managed care environment.

• At least 2 years of progressive leadership experience, including direct team management and accountability for performance.

• Proven track record in leading operational functions with responsibility for quality, productivity, and financial outcomes (e.g., savings, cost containment, or margin impact).

• Experience in creating and implementing performance frameworks, such as KPIs, SLAs, and quality assurance programs.

• Demonstrated capability to analyze complex data sets, identify trends, and drive operational and financial enhancements.

• Experience managing or collaborating on system implementations, workflow optimization, or automation projects.

• Strong background in managing escalations, complex case reviews, and high-risk determinations.

• Experience collaborating cross-functionally with product, technology, compliance, and client-facing teams.

• Familiarity with client-facing environments, including support for client strategy, reporting, and/or presentations to stakeholders.

🏝️ Benefits

• Competitive benefits package with generous employer contributions.

• Flexible and remote working options available.

• 401k plan with a generous employer match and immediate vesting.

• Opportunities for personal and professional development.

• Supportive family benefits, including paid leave for new family members.

• Companywide philanthropic program, Valenz Communities Connection.