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(r).
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
- 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
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.
ChristianaCare Health System is headquartered in Wilmington, Delaware and is one of the country's largest health care providers, ranking 21st in the nation for hospital admissions. Christiana Care is proudly a Nurse Magnet recognized institution. Christiana Care Health System is also one of the largest health care providers in the mid-Atlantic region, serving all of Delaware and portions of seven counties bordering the state in Pennsylvania, Maryland and New Jersey. A not-for-profit, non-sectarian health system, Christiana Care includes two hospitals with more than 1,100 patient beds, and is a major teaching hospital with two campuses. Christiana Care is continually recognized for excellence on a regional and national level. Our role in the community is expressed in the Christiana Care Way: "We serve our neighbors as respectful, expert, caring partners in their health. We do this by creating innovative, effective, affordable systems of care that our neighbors value."Christiana Care is a great place to work because we value diversity and recognize it to be a core part of our success. Because of the diversity of our employees, affiliated health professionals and volunteers, we are ...positioned to meet the unique needs of our patients and community. We acknowledge and celebrate the uniqueness and talent of each employee. Because of our talented workforce we are able to provide a quality healthcare experience to our patients and community. We strive to create an inclusive environment in which individual diversity can be leveraged and thrive. 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.