Sr Director of Patient Access and Utilization Management

Nashville General Hospital Nashville, TN, US

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 functions. In 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:

Bachelor’s - Nursing, Business Administration, Healthcare Administration, or related field (Required)

Master’s 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 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

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.

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.

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.

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.

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.

Community & Academic Partnership

• Lead and oversee contract management, including review, approval, and storage.
• 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 $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 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

#INDOTH2025

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