Utilization Management & CDI Director

Utilization Management & CDI Director page is loaded## Utilization Management & CDI Director locations:
Genesis Hospital time type:
Full time posted on:
Posted Yesterday job requisition :
JR105469#
** GENESIS HEALTHCARE SYSTEM
** In order to fill our Mission of serving our community by helping each person achieve optimal health and well-being by providing compassionate, exceptional, and affordable healthcare services, all employees of Genesis Health Care System must be committed to living the Genesis Mission and Genesis values of Compassion, Excellence, Integrity, Team, and Innovation. All employees must regard themselves as an ‘owner’ of Genesis and keep our patients at the center of everything we do *- always.*##

Position Details:

Work Shift:

Day Shift (United States of America)
Scheduled Weekly

Hours:

40

Department:

Utilization Management## Overview of Position:

The Director of Utilization Management and Clinical Documentation Integrity is responsible for strategic oversight, leadership, and integration of utilization management and clinical documentation quality across hospital and outpatient services. This role ensures effective care coordination, appropriate resource utilization, high-quality clinical documentation, regulatory compliance, and optimal reimbursement. The Director partners with clinical, operational, and revenue cycle leaders to develop best practices and empower multidisciplinary teams.
** ESSENTIAL DUTIES
** 1.
Lead and manage utilization review processes and clinical documentation improvement programs for all hospital inpatient, emergency department, and outpatient locations.  2.
Develop, implement, and monitor system-wide policies and workflows supporting timely, medically appropriate admissions, continued stays, and transitions of care.  3.
Oversee the Clinical Documentation Integrity (CDI) team, ensuring accurate, thorough, and compliant documentation for quality outcomes and optimal coding/reimbursement.  4.
Collaborate with physicians, APPs, nursing, case management, and coding teams to provide education and performance feedback on documentation and utilization practices.  5.
Analyze and report utilization management and CDI metrics to executive leadership, identifying trends, gaps, and opportunities for improvement.  6.
Ensure compliance with state, federal, and payer guidelines (e.g., Medicare conditions of participation, managed care rules).  7.
Participate in system-level committees for quality improvement, risk management, revenue cycle, and clinical transformation.  8.
Lead initiatives to integrate new technology solutions (EHR, analytics, decision support) supporting utilization management and clinical documentation excellence.  9.
Support outpatient facilities in the adoption of documentation improvement best practices and utilization review processes.  10.
Serve as a resource to provider groups, coding teams, and case management for complex cases and escalations.
** QUALIFICATIONS
* * 1.
Master’s Degree in Nursing, Health Administration, HIM, or related field required.  2.
Five (5) years of progressive leadership experience in hospital and outpatient utilization management and clinical documentation integrity.  3.
Deep knowledge of regulatory requirements, payor standards, documentation/coding principles, and healthcare delivery across care settings.  4.
Demonstrated skill in team leadership, process redesign, data analytics, and provider engagement.  5.
Excellent communication, collaboration, and change management abilities.
** PATIENT CENTERED CARE & BEHAVIORAL EXPECTATIONS
** 1.
Living the Genesis Mission, Vision and Values  
• Performs work in a manner that is quality focused.  
• Treats patients, co-workers, visitors and volunteers with courtesy, compassion, empathy and respect.  
• Results oriented and focused on achievement of objectives.  
• Acknowledges and responds to the diversity of people and the situation.  
• Encourages peers (others) to be owners of change.  
• Always makes the effort to anticipate and exceed customer needs and expectations.  
• Possesses the ability to engage others with patience and understanding.  
• Acts in a manner that creates positive first and lasting…