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 HealthCare 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 impressions.
• Demonstrates the ability to own issues until they are resolved.
2.    Patient Centered Care (patients/families, physicians, co-workers, all other internal/external customers)
• Introduces self and role…connects with everyone.
• Communicates effectively (i.e. advising others of actions, pertinent information, time durations, etc.) and asks for feedback.
• Asks for and anticipates needs and concerns of others.
• Maintains a positive work environment for staff and a healing environment for patients (i.e. safe, clean, quiet, etc.)
• Maintains the dignity and privacy of each person; manages c