Sr Director of Patient Access and Utilization Management
Sr Director of Patient Access and Utilization Management
Posted on :
11-09-2025
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1 Vacancy
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Job Description
Description
Nashville General Hospital is hiring a Sr. Director of Patient Access and Utilization Management.
Join our leadership team and make a lasting impact on patient care! We are seeking an experienced and visionary Senior Director to lead our Patient Access and Utilization Management this key role you will oversee registration financial clearance insurance verification and utilization review programs ensuring seamless patient flow and optimal revenue cycle performance.
If you are a strategic thinker with a passion for improving processes leading high-performing teams and driving compliance with state federal and accreditation standards we want to hear from you!
Education:
Bachelors - Nursing Business Administration Healthcare Administration or related field (Required)
Masters in Healthcare Administration (MHA) Business Administration (MBA) or related advanced degree (Required)
Job Requirement:
- Minimum 10 years of progressive administrative and supervisory experience
- Minimum 8 years in a healthcare management position (preferred)
- Proven ability to handle multiple projects simultaneously with strong budgeting and negotiation skills
- Functional knowledge of computers word processing spreadsheets and hospital information systems (HIS Affinity preferred)
- Thorough knowledge of patient access utilization management and medical terminology
- Detailed knowledge of Joint Commission NCQA CMS state and federal requirements
- Experience with insurance verification coverage interpretation and revenue cycle optimization
- Strong verbal and written communication skills with a proven ability to collaborate with hospital-wide teams
- Demonstrated ability to independently identify problems implement solutions and meet deadlines
About Nashville General Hospital
Nashville General Hospital (NGH) is Nashvilles 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
Core Competencies
Financial & Revenue Cycle Acumen: Expertise in revenue cycle management budget oversight and claim denial reduction.
Operational & Technical Expertise: Skilled at improving workflows using data analytics and enhancing patient satisfaction.
Regulatory & Compliance Knowledge: Deep knowledge of payer regulations and compliance standards for ethical operations.
Strategic Planning & Leadership: Capable of setting direction leading change and driving performance improvements.
Collaborative Communication: Builds strong relationships with physicians senior leaders and payers to achieve results.
Operational & Technical Expertise: Skilled at improving workflows using data analytics and enhancing patient satisfaction.
Regulatory & Compliance Knowledge: Deep knowledge of payer regulations and compliance standards for ethical operations.
Strategic Planning & Leadership: Capable of setting direction leading change and driving performance improvements.
Collaborative Communication: Builds strong relationships with physicians senior leaders and payers to achieve results.
Primary Duties & Responsibilities
Leadership & Oversight
Plan organize and direct the overall operations of Patient Access (PA) and Utilization Management (UM).
Oversee scheduling registration insurance verification financial counseling and admissions functions.
Direct implement and integrate PA functions (scheduling financial clearance registration) and UM functions (denials management peer-to-peer reviews concurrent/retrospective reviews).
Ensure accurate patient status identification and optimal revenue cycle outcomes.
Develop and lead the Utilization Review Committee with consistent physician participation.
Maintain compliance with NCQA Joint Commission CMS and state regulations.
Oversee scheduling registration insurance verification financial counseling and admissions functions.
Direct implement and integrate PA functions (scheduling financial clearance registration) and UM functions (denials management peer-to-peer reviews concurrent/retrospective reviews).
Ensure accurate patient status identification and optimal revenue cycle outcomes.
Develop and lead the Utilization Review Committee with consistent physician participation.
Maintain compliance with NCQA Joint Commission CMS and state regulations.
Financial & Operational Management
Develop inventory and cost accounting policies and reporting.
Analyze departmental performance trends to support forecasting and strategic planning.
Present performance outcomes and improvement initiatives to senior leadership.
Analyze departmental performance trends to support forecasting and strategic planning.
Present performance outcomes and improvement initiatives to senior leadership.
Quality Risk & Compliance
Identify and resolve quality and risk issues.
Develop and implement policies and procedures to increase efficiency and compliance.
Ensure compliance with federal state and local regulations as well as NCQA and Joint Commission standards.
Develop and implement policies and procedures to increase efficiency and compliance.
Ensure compliance with federal state and local regulations as well as NCQA and Joint Commission standards.
Risk Auditing & Investigations
Provide strategic oversight for billing and coding compliance.
Partner with executive leadership on Enterprise Risk Management (ERM) to mitigate compliance risks.
Lead comprehensive auditing and monitoring programs.
Manage confidential reporting systems and investigate compliance concerns.
Design and deliver compliance training for staff medical providers and board members.
Partner with executive leadership on Enterprise Risk Management (ERM) to mitigate compliance risks.
Lead comprehensive auditing and monitoring programs.
Manage confidential reporting systems and investigate compliance concerns.
Design and deliver compliance training for staff medical providers and board members.
Community & Academic Partnership
Lead and oversee contract management including review approval and storage.
Mitigate risk by maintaining a centralized compliant contract management system.
Mitigate risk by maintaining a centralized compliant contract management system.
Our benefits include:
- Medical Dental and Vision Insurance within first 31 days of employment
- Metro Health Incentive Program - Access to high quality healthcare without incurring out-of-pocket expenses
- Short and Long-Term Disability - up to 60% of eligible weekly pay
- Life Insurance -Metro provides you with basic life and AD&D coverage equal to $50000 ($32500 if you are age 65 or older) at no cost to you.
- Retirement Plan - eligible up to IRS max limits and includes company contribution
- Shift and Weekend Differential Pay Offered on Nights and Weekends
- Tuition Reimbursement for employee and dependents
- 12 paid holidays - any holiday worked is another holiday banked
- Flexible Spending Accounts
- Free Parking for all employees
Nashville General Hospital is an Equal Opportunity Employer/Disability/Veteran
We are an E-Verify employer.
For more information please click on the following links:
E-Verify Participation Poster: EnglishSpanish
E-Verify Right to Work Poster: EnglishSpanish
Required Experience:
Director
Employment Type
Full-Time
Department / Functional Area
Key Skills
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