Location: Chicago, Illinois

Business Unit: Rush Medical Center

Hospital: Rush University Medical Center

Department: Patient Access-Pre-Visit

Work Type: Full Time (Total FTE between 0.9 and 1.0)

Shift: Shift 1

Work Schedule: 8 Hr (8:00:00 AM - 4:30:00 PM)

Pay Range: $45.59 - $74.19 per hour
Rush salaries are determined by many factors including, but not limited to, education, job-related experience and skills, as well as internal equity and industry specific market data. The pay range for each role reflects Rush's anticipated wage or salary reasonably expected to be offered for the position. Offers may vary depending on the circumstances of each case.

Summary:
Under the leadership of the System Director of Patient Financial Clearance, the System Manager of Financial Clearance - Pre-Authorization Services provides strategic leadership and operational oversight of pre-authorization functions supporting ambulatory clinics and hospital-based services across the Rush University System for Health. This role ensures that all services requiring prior authorization are secured in accordance with payer policies prior to service delivery, supporting timely patient care while protecting organizational revenue integrity.

This position requires deep subject matter expertise in complex authorization workflows, payer medical necessity requirements, and Epic electronic health record processes. The System Manager provides oversight across high-complexity clinical service lines-including diagnostic imaging, surgical services, and infusion therapies-ensuring documentation meets stringent payer-specific requirements.

The System Manager acts as a vital liaison between physicians, clinical teams, and revenue cycle departments. By aligning clinical orders with payer policies, this role plays a critical part in preventing authorization-related denials, minimizing revenue leakage, and ensuring services are financially secured across the system.

Other information:
Qualifications

Education
• Bachelor's degree in healthcare administration, Business Administration, Finance, or a related field required.
• An equivalent combination of education and progressively responsible healthcare revenue cycle experience may be considered in lieu of a bachelor's degree.
• Master's degree preferred.

Experience
• Minimum of 5-7 years of experience in healthcare revenue cycle operations, with significant focus in prior authorization, financial clearance, or patient access functions.
• Minimum of 3 years of leadership or management experience, preferably in a system or multi-site environment.
• Demonstrated experience supporting complex authorization workflows for diagnostic imaging, surgical services, and infusion therapies.
• High proficiency in Epic authorization workflows and work queue management.
• Experience collaborating with physicians and clinic operations is strongly preferred.

Knowledge & Skills
• Advanced knowledge of payer authorization requirements, medical necessity policies, and reimbursement guidelines.
• Strong understanding of authorization lifecycle management, including clinical documentation requirements and payer review processes.
• Demonstrated expertise in Epic authorization workflows, work queues, and electronic order-driven authorization processes.
• Ability to interpret payer policies and translate requirements into operational workflows.
• Experience analyzing operational and financial performance data to support denial prevention and revenue optimization.
• Strong leadership, communication, and relationship-management skills.
• Exceptional organizational, analytical, and problem-solving abilities.
• Ability to lead operational improvements in a complex healthcare environment.

Core Competencies
• Authorization & Payer Policy Expertise
• Revenue Integrity & Financial Stewardship
• Operational Leadership
• Provider & Clinical Partnership
• Financial Clearance Optimization
• Process Improvement & Innovation
• Strategic Collaboration

Responsibilities:
Operational Leadership
• Provide leadership and operational oversight for financial clearance teams responsible for securing prior authorizations across multiple outpatient and hospital-based service lines.
• Ensure staff follow standardized workflows for obtaining authorizations in accordance with payer policies, medical necessity guidelines, and service-specific requirements.
• Oversee authorization operations for diagnostic imaging, surgical procedures, outpatient procedures, in-office procedures, and infusion services, ensuring appropriate clinical information is obtained and submitted to payers.
• Maintain operational knowledge of complex payer requirements, authorization pathways, and service-specific review criteria that impact approval outcomes.

Authorization Workflow Expertise
• Provide subject matter expertise in authorization lifecycle management, including order review, clinical documentation verification, submission processes, payer follow-up, and approval tracking.
• Ensure appropriate alignment between clinical orders, procedural coding, and payer authorization requirements to support accurate submission and approval.
• Maintain expertise in payer medical necessity guidelines, documentation requirements, and service-specific authorization pathways.
• Identify and resolve operational barriers that delay or prevent authorization approvals.

Epic Workflow and Technology Optimization
• Serve as an operational expert in Epic authorization and referral workflows, including order-driven authorization processes, work queues, and authorization tracking tools.
• Ensure optimal use of Epic functionality to support efficient authorization management, including documentation capture, order review, and work queue prioritization.
• Partner with information technology and revenue cycle leadership to improve Epic workflows related to authorization management, clinical documentation integration, and operational reporting.
• Support implementation and optimization of automation tools and technology solutions that improve authorization efficiency and payer communication.

Revenue Cycle Performance
• Support the organization's revenue cycle by ensuring services requiring authorization are appropriately cleared prior to service delivery.
• Monitor authorization approval rates, payer turnaround times, and denial trends to identify operational risks and revenue protection opportunities.
• Develop and implement strategies to reduce authorization-related denials and payer escalations.
• Collaborate with revenue cycle leadership to support financial clearance metrics and organizational revenue goals.
• Ensure staff if following the Point of Service Collection.

Provider and Clinic Collaboration
• Partner closely with physicians, advanced practice providers, and clinic leadership to ensure clinical documentation and supporting information align with payer requirements.
• Provide expertise to clinical departments regarding payer policies, medical necessity documentation, and authorization submission requirements.
• Serve as a liaison between clinical teams, financial clearance staff, and revenue cycle operations to resolve authorization barriers and support timely patient care.

Team Leadership and Development
• Recruit, train, mentor, and manage financial clearance staff responsible for authorization operations.
• Develop team expertise in complex payer authorization requirements, service-specific workflows, and clinical documentation standards.
• Establish productivity, quality, and service level expectations for authorization teams.
• Foster a culture of accountability, collaboration, and operational excellence.
• Strong focus and plan on nurturing a top tier work environment for employees to meet organizational goals of staff engagement

Process Improvement and Operational Excellence
• Lead initiatives to improve authorization turnaround times, reduce rework, and strengthen documentation accuracy.
• Analyze operational workflows to identify opportunities for standardization, automation, and improved payer response management.
• Drive continuous improvement initiatives that strengthen financial clearance performance and revenue protection.

Operational Performance and Reporting
• Monitor key performance indicators including authorization turnaround times, approval rates, denial trends, payer response timelines, and service level compliance.
• Develop operational reporting to identify workflow gaps, payer issues, and process improvement opportunities.
• Provide leadership with actionable insights related to authorization performance and revenue cycle impact.