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Everyone at Emanate Health plays a vital role in the care we deliver. No matter what department you belong to, the work you do at Emanate Health affects lives. When you join Emanate Health, you become part of a team that works together to strengthen our communities and grow as individuals.

On Glassdoor's list of "Best Places to Work" in 2021, Emanate Health was named the #1 ranked health care system in the United States, and the #19 ranked company in the country.

Job Summary

The Director of Revenue Integrity & Clinical Utilization Review provides clinical oversight and operational leadership for clinical utilization review, charge capture, and revenue integrity functions. This position is responsible for managing medical necessity reviews, payer audits, clinical denials, and charge accuracy across the care continuum. The director develops and implements strategies to prevent revenue leakage, ensure defensible billing, and align operations with regulatory standards to optimize reimbursement and patient care outcomes.

Job Requirements

Minimum Education Requirement :

Bachelor’s Degree in Nursing (BSN) or Healthcare Administration preferred.

Minimum Experience Requirement :

Minimum ten (10) years of combined experience in utilization management, revenue cycle, or charge integrity; at least two (2) years in a supervisory/leadership role. Proficient in InterQual/MCG, payer criteria, and clinical documentation standards. Working knowledge of charge capture workflows, billing practices, and revenue cycle systems. Experience with Meditech, Cerner, or other EMR and charge capture platforms preferred.

Minimum License Requirement :

 California RN license.

Delivering world-class health care one patient at a time.

Pay Range: