Tracking Code

2023-16832

Position Type

Full-Time

Shift

Day

Job Location

Jacksonville, Illinois

Description

Under the direct supervision of the Director, Compliance Risk & Revenue Integrity, this role is responsible for the development, implementation, and monitoring of Clinical Documentation Improvement and Utilization Management Specialists, Utilization Management/Clinical Documentation Improvement Clerk and overall performance of the department.

Required Skills

• Professionally and courteously interacts with the patients, general public, physicians, hospital personnel, and outside entities.

• Provides operational leadership to identify, implement, and monitor UM/CDI operational activities

• Facilitates workgroups to document UM/CDI processes to improve outcomes, maximize resource utilization, and improve organizational efficiencies.

• Evaluates caseload and capacity of colleagues and distributes workload accordingly.

• Manages the time and attendance of supervised colleagues.

• Provides reports and data as requested by the supervisor and Strategic Leadership team.

• Promotes UM and CDI as a key aspect of patient care, providing education to staff and medical team.

• Develops, maintains, and conducts department orientation program.

• Develops, maintains, and communicates department job descriptions, policies and procedures.

• Prepares and recommends department budget and assures that the department operates within set budget.

• Evaluates colleague performance and implements disciplinary actions when warranted, objectively and timely.

• Participates in administrative staff meetings and conducts monthly department meetings.

• Manages projects as assigned.

• Protects the confidentiality of the patient information at all times.

• Develops relationships with professional affiliations and other to maintain professional growth and development.

• Monitors action plans to address identified CDI and UM deficiencies.

• Performs other related work as required or requested.

The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job. Incumbents may be requested to perform tasks other than those specifically presented in this description.

11/18

Required Experience

Education:

• Bachelor’s Degree in Nursing required

Licensure/Certification/Registry:

• Current RN license in the state of Illinois

Experience:

• Minimum five (5) years recent hospital based patient care
• Minimum three (3) year experience with Milliman and/ or InterQual
• Minimum one (1) year experience with supervisory/ management experience
• HMO, managed care, PPO, Utilization Management experience

Other Knowledge/Skills/Abilities:

• Knowledge and skill in the use of computer software applications for drafting documents, data management, and tracking.
• Excellent communication, interpersonal, and organizational skills.