KnowHireMatch
Director Case Management / Utilization Management / CDI Location: Buckey
KnowHireMatch, Buckeye Lake, Ohio, us, 43008
Director Case Management / Utilization Management / CDI
Location: Buckeye Lake, OH
Base Pay Range $130,000.00/yr - $156,000.00/yr
Now is your chance to join a Forbes magazine top 100 hospital where career growth and opportunity await you. The hospital is committed to building healthcare teams whose care exceeds the expectations of patients and the community. We are looking for quality talent who share our values.
Responsibilities
Develop, plan, evaluate, and coordinate comprehensive patient care across the continuum to enhance quality patient care and promote cost‑effective resource utilization.
Provide director‑level oversight of Inpatient and ED Case Management, Utilization Management, and Clinical Documentation Integrity programs, ensuring alignment with organizational goals and regulatory requirements.
Monitor patient care, including utilization, quality assurance, discharge planning, continuity of care, and case management activities, ensuring integration into overall hospital operations.
Coordinate and monitor activities with appropriate members of the health‑care team to promote efficient use of hospital resources, facilitate timely discharges, prevent and control infections, promote quality patient care, and reduce risk and liability.
Collaborate closely with coders and revenue cycle teams to optimize clinical documentation and support accurate coding, reimbursement, and compliance initiatives.
Identify tracking mechanisms to evaluate and achieve optimal financial outcomes, enhance quality patient care, and promote cost‑effective resource utilization.
Use data to drive decisions, plan, and implement performance improvement strategies for case management, utilization management, and clinical documentation integrity.
Coordinate daily activities of the Case Management, UM, and CDI Department to promote quality patient care, efficient use of hospital resources, facilitate timely discharges, and reduce risk and liability.
Investigate and initiate follow‑up on utilization denials, contract negotiations, and external regulatory agencies’ requirements.
Direct operations of the Physician Advisor Program, including analysis of performance through reporting, committee involvement, and oversight.
Actively serve on hospital committees and teams and facilitate opportunities for employees to do the same.
Develop, perform, and improve personal and departmental knowledge of computer software and reporting functions.
Organize and oversee the maintenance of denial and appeal activity and follow up with physicians and others when indicated.
Prepare or coordinate the preparation of periodic and special reports required by various agencies, insurance contracts, and hospital committees.
Analyze and trend data results to incorporate efforts and information into existing systems to optimize the efficiency of operational systems through strategic quality leadership.
Facilitate growth and development of the case management program, utilization management (including Physician Advisor Program and Clinical Documentation Integrity) in response to the dynamic nature of the health‑care environment through benchmarking for best practices, networking, quality management, and other activities.
Develop new resources where gaps exist in the system as identified through research and data analysis to meet and enhance the quality/efficiency of comprehensive patient care and basic human needs for the community.
Interact with Corporate Consulting and Business office on issues such as contracting, billing, reimbursement, denials, and physician reports cards, and collaboratively initiate improvements related to these areas.
Maintain hospital compliance with the Quality Improvement Organization (QIO) and CMS guidelines.
Maintain professional knowledge by participating in educational seminars and opportunities.
Participate in Population Health work at an organizational level, including active involvement with the System‑Wide Care Management Team and Value‑Based Care Delivery.
Additional Information
The position reports to a Manager who is highly respected in the organization. The role is opening due to that Manager’s retirement.
The team consists of approximately 50–60 professionals across CM/UM/CDI. EPIC (EMR) is used, and the facility has extensive technology infrastructure.
Requirements
Master’s degree in Nursing, Healthcare Administration, or Business Administration (required).
Current Ohio RN licensure (or active multi‑state licensure).
Certified Case Manager (CSM).
At least three (3) years of management or demonstrated leadership experience.
Knowledge of prospective payment systems, managed care, infection control surveillance, patient care, disease processes, discharge planning, and continuum of services offered within Genesis and externally. Knowledge of coding, mid‑revenue cycle, CDI, physician advisor, and payor relations.
Ability to perform data analysis and utilize computer systems to record and communicate information to other services.
Ability to lead collaboration with other leaders in the organization, especially regarding the delivery of high‑quality, timely, and right‑site care.
Excellent leadership, verbal, and organizational skills to steer the case management process.
Benefits
Full‑time position.
Hourly range starts at $62.50 ($130,000 annually) and may increase to $75 ($156,000 annually) based on experience.
Full benefits package is offered.
Seniority Level Director
Employment Type Full‑time
Job Function Other
Industries IT Services and IT Consulting
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Base Pay Range $130,000.00/yr - $156,000.00/yr
Now is your chance to join a Forbes magazine top 100 hospital where career growth and opportunity await you. The hospital is committed to building healthcare teams whose care exceeds the expectations of patients and the community. We are looking for quality talent who share our values.
Responsibilities
Develop, plan, evaluate, and coordinate comprehensive patient care across the continuum to enhance quality patient care and promote cost‑effective resource utilization.
Provide director‑level oversight of Inpatient and ED Case Management, Utilization Management, and Clinical Documentation Integrity programs, ensuring alignment with organizational goals and regulatory requirements.
Monitor patient care, including utilization, quality assurance, discharge planning, continuity of care, and case management activities, ensuring integration into overall hospital operations.
Coordinate and monitor activities with appropriate members of the health‑care team to promote efficient use of hospital resources, facilitate timely discharges, prevent and control infections, promote quality patient care, and reduce risk and liability.
Collaborate closely with coders and revenue cycle teams to optimize clinical documentation and support accurate coding, reimbursement, and compliance initiatives.
Identify tracking mechanisms to evaluate and achieve optimal financial outcomes, enhance quality patient care, and promote cost‑effective resource utilization.
Use data to drive decisions, plan, and implement performance improvement strategies for case management, utilization management, and clinical documentation integrity.
Coordinate daily activities of the Case Management, UM, and CDI Department to promote quality patient care, efficient use of hospital resources, facilitate timely discharges, and reduce risk and liability.
Investigate and initiate follow‑up on utilization denials, contract negotiations, and external regulatory agencies’ requirements.
Direct operations of the Physician Advisor Program, including analysis of performance through reporting, committee involvement, and oversight.
Actively serve on hospital committees and teams and facilitate opportunities for employees to do the same.
Develop, perform, and improve personal and departmental knowledge of computer software and reporting functions.
Organize and oversee the maintenance of denial and appeal activity and follow up with physicians and others when indicated.
Prepare or coordinate the preparation of periodic and special reports required by various agencies, insurance contracts, and hospital committees.
Analyze and trend data results to incorporate efforts and information into existing systems to optimize the efficiency of operational systems through strategic quality leadership.
Facilitate growth and development of the case management program, utilization management (including Physician Advisor Program and Clinical Documentation Integrity) in response to the dynamic nature of the health‑care environment through benchmarking for best practices, networking, quality management, and other activities.
Develop new resources where gaps exist in the system as identified through research and data analysis to meet and enhance the quality/efficiency of comprehensive patient care and basic human needs for the community.
Interact with Corporate Consulting and Business office on issues such as contracting, billing, reimbursement, denials, and physician reports cards, and collaboratively initiate improvements related to these areas.
Maintain hospital compliance with the Quality Improvement Organization (QIO) and CMS guidelines.
Maintain professional knowledge by participating in educational seminars and opportunities.
Participate in Population Health work at an organizational level, including active involvement with the System‑Wide Care Management Team and Value‑Based Care Delivery.
Additional Information
The position reports to a Manager who is highly respected in the organization. The role is opening due to that Manager’s retirement.
The team consists of approximately 50–60 professionals across CM/UM/CDI. EPIC (EMR) is used, and the facility has extensive technology infrastructure.
Requirements
Master’s degree in Nursing, Healthcare Administration, or Business Administration (required).
Current Ohio RN licensure (or active multi‑state licensure).
Certified Case Manager (CSM).
At least three (3) years of management or demonstrated leadership experience.
Knowledge of prospective payment systems, managed care, infection control surveillance, patient care, disease processes, discharge planning, and continuum of services offered within Genesis and externally. Knowledge of coding, mid‑revenue cycle, CDI, physician advisor, and payor relations.
Ability to perform data analysis and utilize computer systems to record and communicate information to other services.
Ability to lead collaboration with other leaders in the organization, especially regarding the delivery of high‑quality, timely, and right‑site care.
Excellent leadership, verbal, and organizational skills to steer the case management process.
Benefits
Full‑time position.
Hourly range starts at $62.50 ($130,000 annually) and may increase to $75 ($156,000 annually) based on experience.
Full benefits package is offered.
Seniority Level Director
Employment Type Full‑time
Job Function Other
Industries IT Services and IT Consulting
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