Director Denial Management and Prevention (RN)

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Director Denial Management and Prevention (RN) based in United States. This leadership role oversees denial prevention, recovery, and appeals operations across a multi-hospital healthcare system. The position combines clinical expertise, revenue cycle knowledge, analytics, and strategic leadership to reduce denials and improve reimbursement outcomes. You will partner with senior clinical and operational leaders to identify mitigation opportunities and implement sustainable improvements across hospital entities. The role provides strategic direction and clinical oversight for denial and appeal activities while using performance data and industry benchmarks to drive results. You will also collaborate with case management, managed care, compliance, reimbursement, and external business partners to address payer and regulatory challenges. A key focus will be developing standardized analytics, strengthening operational processes, and optimizing technology to improve efficiency. This is a fully remote, full-time leadership opportunity for an experienced RN with strong revenue cycle and denial management expertise. Accountabilities - Partner with senior clinical resource management and organizational leaders to identify denial mitigation opportunities and develop reimbursement improvement strategies. - Oversee system-wide denial appeals operations, including the performance and accountability of external appeal vendors. - Provide strategic direction and clinical oversight for hospital denial management, prevention, recovery, and appeal outcomes. - Develop and implement sustainable operational improvements that support organizational financial and clinical objectives. - Establish performance goals and objectives using industry best practices, internal benchmarks, and denial management trends. - Develop and maintain analytics, reporting tools, and dashboards that standardize denial summaries and support system-wide decision-making.

- Lead denial mitigation initiatives and serve as a subject matter consultant to individual hospital entities regarding denial trends, root causes, and interventions. - Partner with Acute Case Management teams to improve operational processes, provide education, and support denial reduction efforts. - Collaborate with Managed Care teams to identify, summarize, and address payer-related opportunities and challenges. - Work with Corporate Compliance and Rates and Reimbursement teams to ensure denial management operations and policies align with applicable governmental and state regulations. - Manage business partner and vendor relationships, ensuring contractual obligations and performance expectations are consistently met. - Support the optimization and effective use of technology to improve operational efficiency, denial prevention, and reimbursement performance. - Communicate performance trends, opportunities, and recommendations effectively to leaders and stakeholders across the organization. Requirements: - Hold a Bachelor's degree in Nursing. - Bring 5–7 years of revenue cycle experience, including direct experience with appeals and financial clearance. - Have leadership experience within healthcare, with revenue cycle leadership experience strongly preferred. - Maintain an active Registered Nurse (RN) state license and/or compact state licensure. - Demonstrate strong knowledge of denial management, appeals, reimbursement processes, and healthcare revenue cycle operations. - Possess strong analytical and problem-solving abilities, with a high level of accuracy and attention to detail. - Demonstrate excellent interpersonal and team-building skills with the ability to develop productive relationships across departments.