Job Description

TITLE: Director Case Management / Utilization Management / CDI
Location: Buckeye Lake, OH
Now is your chance to join a Forbes magazine top 100 hospital where career growth and opportunity await you.
They are committed to building healthcare teams whose care exceeds the expectations of their patients and community and are looking for quality talent who share the same values.
They're nestled in a beautiful rural setting but close enough to the big city to enjoy that too!
If that sounds like the change you are looking for, please read on...
What they're looking for:

• 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 required.
• 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 to utilize computer systems to record and communicate information to other services.
• The ability to lead collaboration with other leaders in the organization, especially about the delivery of high-quality, timely, and right site of care.
• Excellent leadership, verbal and organizational skills to order to steer the case management process.

Hours and compensation potential:

• The position is full time.
• The range starts at $62.50hr($130K)-$75hr($156K) depends on years of experience.
• Full benefits package being offered.

What you'll be doing:

• Responsible for developing, planning, evaluating, and coordinating comprehensive patient care across the continuum, to enhance quality patient care while simultaneously promoting cost-effective resource utilization.

Provides director-level oversight of Inpatient and ED Case Management, Utilization Management and Clinical Documentation Integrity programs, ensuring alignment with organizational goals and regulatory requirements.
Monitors patient care, including utilization, quality assurance, discharge planning, continuity of care, and case management activities, and ensures that these functions are integrated into overall hospital operations.
Coordinate and monitors 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.
Collaborates closely with coders and revenue cycle teams to optimize clinical documentation and support accurate coding, reimbursement, and compliance initiatives.

• Responsible for identifying tracking mechanisms in order to evaluate and achieve optimal financial outcomes, to enhance quality patient care, and promote cost-effective resource utilization.
• Uses data to drive decisions, plan, and implement performance improvement strategies for case management, utilization management, and clinical documentation integrity
• Coordinates daily activities of the Case Management, UM, and CDI Department in order to promote quality patient care, efficient use of hospital resources, facilitate timely and adequate discharges, and reduce risk and liability.
• Investigates and initiates follow-up on utilization denials, contract negotiations, and external regulatory agencies' requirements.
• Directs operations of our Physician Advisor Program, including analysis of performance through reporting and committee involvement and oversight.
• Actively serves on hospital committees and teams and facilitates opportunities for employees to do the same.
• Develops, performs, and improves personal and departmental knowledge of computer software and reporting functions.
• Organizes and oversees the maintenance of denial and appeal activity. Follows up with physicians and others when indicated.
• Prepares or coordinates the preparation of periodic and special reports required by various agencies, insurance contracts, and for hospital committees.
• Analyzes and trends data results in order to incorporate efforts and information results with existing systems to optimize the efficiency of operational systems through strategic quality leadership.
• Facilitates growth and development of the case management program, utilization management ( including physician advisor program and clinical documentation integrity (CDI), in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities, as needed.
• 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/or 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.
• Maintains hospital compliance with the Quality Improvement Organization (QIO) and CMS guidelines.
• Maintains professional knowledge by participating in educational seminars and opportunities.
• Participates in Population Health work at an organizational level, including active involvement with the System-Wide Care Management Team and Value-Based Care Delivery.

Additional info:

• Position will report to a Manager that is well respected in the organization. Position is open as the person is retiring.

They use EPIC(EMR) and the facility has a lot of technology. Person would be over about 50-60 people between CM/UM/CDI. Great team to work with.

• If you're a passionate Pharmacist and seeking a rewarding career in a collaborative healthcare setting, this is the opportunity you've been waiting for.

Join us in east central Ohio, and become part of our exceptional team dedicated to delivering high-quality care to our community. Apply now and embark on a fulfilling career journey with us.

Skills Required