• Enhance and Review Clinical Solutions: Utilize expertise to assist in the enhancement and review of readmissions, place of service, and other clinical solutions. • Collaborative Development: Work with a multi-disciplinary team of programmers, operations staff, product leaders, and auditors to bring DRG process ideas from creation to implementation. • Regulatory Monitoring: Assess and adjust written rules by monitoring their effectiveness, keeping up with regulatory updates, and making necessary changes. • Team Leadership: Lead the DRG team by providing guidance, counsel, and development plans to ensure long-term retention and professional growth of DRG staff. • Claims Review Management: Oversee the entire process of clinical claims review, understanding various client configurations and workflows. • Operational Oversight: Manage scheduling, reporting to management, issue resolution, and execution of plans. • Work Coordination: Assign and prioritize work, set goals, and coordinate daily activities of the team. Provide regular updates and communication through one-on-one and team meetings. • Performance Monitoring: Monitor individual and team results to ensure timely completion of work in accordance with department standards and medical policy guidelines. • Analytical Problem-Solving: Demonstrate analytical skills to identify problems and trends, develop solutions, and implement action plans. • Policy and Process Development: Develop departmental policies, processes, and training standards. • Support and Evidence: Provide internal and external partners with evidence and references supporting industry standards, auditing guidelines, and review stances. • Performance Reporting: Provide reports on key performance indicators, including quality scores, workflows, savings, revenue projections, and inventory on a predetermined schedule. • Solution Development: Collaborate with a multi-disciplinary team to suggest solution development, including operations, product, data analytics, and technology. • Timeline Management: Set timelines and ensure communication on progress, tracking delivery, and escalating roadblocks or dependencies. • Program Deployment: Design and deploy effective programs/solutions to identify and correct claims with aberrant results, providing feedback to resolve root causes. • Research and Special Projects: Assist with research, special projects, and ad hoc claim reviews as needed. • Other Duties: Perform other duties as assigned.