[Hiring] Associate Director, Clinical Operations @UnitedHealth Group

Role Description

The Associate Director of Clinical Operations is responsible for leading Clinical Itemized Bill Review (IBR) operations supporting UnitedHealthcare and commercial payer clients. As a Registered Nurse with extensive expertise in healthcare revenue cycle, facility reimbursement, and payment integrity, this leader drives clinical review strategies that identify reimbursement opportunities, support accurate claim adjustments, and ensure compliance with CMS guidelines and client requirements.

This role provides leadership for a team of clinical leaders and reviewers, while partnering with resources to support operational consistency and business objectives. The Associate Director serves as the primary clinical subject matter expert for the IBR product, supporting complex client and provider discussions involving inpatient and outpatient facility billing, reimbursement methodologies, and adjustment rationale.

The position plays a critical role in advancing product strategy, developing clinical review methodologies, and delivering significant financial value through accurate, defensible, and clinically sound claim reviews.

This position combines clinical leadership with deep expertise in facility reimbursement and healthcare revenue cycle operations. The Associate Director serves as a trusted advisor and recognized subject matter expert, influencing clinical review methodology, product strategy, client outcomes, and reimbursement accuracy across a high-impact payment integrity program.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Qualifications

• Active, unrestricted Registered Nurse (RN) license
• 5+ years of experience in healthcare revenue cycle, payment integrity, facility reimbursement, or related healthcare operations
• 2+ years of experience reviewing and analyzing inpatient and outpatient facility claims
• 2+ years of experience applying CMS guidelines, UB-04 billing requirements, revenue codes, MS-DRGs, APCs, hospital charging practices, and reimbursement methodologies
• 1+ year of leadership experience managing clinical staff and leading cross-functional initiatives
• 1+ year of experience presenting complex adjustment rationale and reimbursement concepts to clients, providers, and senior leadership

Requirements

• Lead day-to-day clinical operations for pre-payment and post-payment facility claim reviews
• Manage and develop clinical leaders and staff to achieve productivity, quality, and financial objectives
• Monitor operational performance and drive process improvements to enhance efficiency and outcomes
• Partner with offshore resources to support consistent execution of clinical review activities
• Serve as a senior clinical resource for complex inpatient and outpatient facility claim reviews
• Apply advanced knowledge of CMS guidelines, hospital billing practices, reimbursement methodologies, and payment integrity concepts to identify reimbursement opportunities and support adjustment recommendations
• Ensure review findings are clinically sound, compliant, and defensible
• Act as the primary clinical SME for the IBR product and review methodologies
• Participate in client, provider, and leadership discussions involving complex reimbursement and billing issues
• Clearly communicate adjustment rationale, clinical findings, and reimbursement concepts to internal and external stakeholders
• Support escalated client and provider inquiries requiring advanced clinical and reimbursement expertise
• Lead the development and maintenance of clinical review concepts, reimbursement policies, and audit methodologies
• Partner with product and technology teams to enhance review capabilities and operational effectiveness
• Monitor regulatory and industry changes to ensure review methodologies remain current and effective

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)