Director, Utilization Management/CDI

Job Requisition #: JR59464

End Date: 1/31/2022

Location: Newark, Delaware

Position Type: Case Management/Social Worker, Management/Executive, Nursing, Pharmacy, Professional

Shift: Day Shift, No Rotation

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ChristianaCare, with Hospitals in Wilmington and Newark, DE, as well as Elkton, MD, is one of the largest health care providers in the Mid-Atlantic Region. Named one of “America's Best Hospitals” by U.S. News & World Report, we have an excess of 1,100 beds between our hospitals and are committed to providing the best patient care in the region.  We are proud to say that Christiana Hospital, Wilmington Hospital, our Ambulatory Services, and HomeHealth have all received ANCC Magnet Recognition®. 

 

We are currently seeking a Director for our Utilization Management/CDI team.  The successful candidate will be responsible for ongoing development and execution of key strategic initiatives for utilization management and clinical documentation improvement teams.

 

PRINCIPAL DUTIES AND RESPONSIBILITIES:

-         Provides strategic planning and oversight of the Clinical Documentation Improvement and Utilization Management Programs

-         Ensures the success of major revenue cycle initiatives.

-         Ensures that staff are abreast with regulatory and compliance changes t

-         Reviews data / metrics pertaining to utilization management and clinical documentation improvement with providers and Department Chairs or Section Heads on a regular basis

-         Interfaces with compliance, senior leadership, and key physician leaders within the health system as it begins to manage population health-based contracts.

-         Reviews externally reported data from CMS Pay-for-performance programs and Vizient Clinical Database to identify opportunities to improve risk adjustment

-         Develops strategies to improve resource utilization capture, risk adjustment and other quality measures.

-         In conjunction with other department heads (HIM, Revenue Cycle), leads the effort to ensure that accurate DRG-based reimbursement for the hospital is achieved and claim denials are reduced, by ensuring documentation integrity.

-         Directs managers and other leaders across the enterprise-wide denials management team to assure the integrity and stability of the daily performance of denials and appeals related operations

 

EDUCATION AND EXPERIENCE REQUIREMENTS:

 

-         Bachelor's Degree required; Master's preferred

-         Formal Clinical Training (RN, RT, Pharmacist, PT) with appropriate professional license required

-         Three (3) years' experience in both Utilization Management and Case Management

-         Three (3) years' supervisory/management experience

-         CPHQ, CCM, CCDS, CHCQM, or CHRI certification preferred

-         Maintains required documented hours of relevant continuing education related to licensure requirements

 

CHRISTIANACARE OFFERS:

-         Flexible work schedule including some remote work

-         Full Medical, Dental, Vision and other insurance benefits

-         403 (b) with an employer match

-         Generous Paid Time Off

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EEO Statement: Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.


UPDATE: ChristianaCare is committed to prioritizing the health and safety of our patients and caregivers. As we continue to meet the needs of our caregivers and our community through the COVID-19 pandemic, our commitment to health and safety requires that we take new steps to ensure a safe environment for medical care for our patients and a workplace that avoids preventable harm for our caregivers. For this reason, vaccination for COVID-19 is required for all caregivers at ChristianaCare and is considered a safety standard that is job-related and consistent with business necessity for all caregivers.

Why do WE offer careers full of possibilities?

For the Love of Health.

Inclusion & Diversity

At ChristianaCare, we’re committed to treating everyone with dignity and respect. We believe in a safe, inclusive work environment that fosters collaboration between caregivers from all walks of life. We know that each unique viewpoint is vital in delivering high-quality, safe patient care to everyone who walks through our doors. Our policies, benefits, hiring practices, employee resource groups, and corporate citizenship demonstrate our commitment to inclusion and diversity throughout our system.

Why do we embrace inclusion and diversity? For the Love of Health.

Our Values

We serve together in Love and Excellence. Our unique values, Love and Excellence are bold and powerful, and they are the reason why working for ChristianaCare is special. The behaviors associated with our values guide how caregivers interact with everyone they work with and make for an exceptional work experience. We believe that when you lead with Love, Excellence is inevitable.

Benefits

ChristianaCare’s comprehensive total rewards package is one of the most competitive in the region. We are proud to offer excellent benefits that reflect the organization’s commitment to being exceptional today and even better tomorrow.

At ChristianaCare, we provide access to high-quality and affordable benefits designed to meet our caregivers where they are. You can tailor your benefits to meet your needs now and adjust them as your priorities change.

Take advantage of ChristianaCare’s wide-ranging benefit offerings from supporting optimal health through medical, prescription, dental and vision coverage to valuable wellness and work/life programs, which include paid parental leave, coverage for infertility and assisted reproductive technologies, an employer-funded short-term disability program, and more.

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Our Region

A Great Place To Live

Our region offers a diversity of cultures, lifestyles, sports and entertainment events, housing options and educational opportunities. Located between Philadelphia and Washington, D.C., our locations provide easy access to two international airports, employment opportunities in a tri-state area, and proximity to some of the nation's top universities and colleges, as well as beaches in MD, DE and NJ!

Why Delaware? Why Maryland?
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We Serve Together

For the Love of Health

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