Director, Utilization Management/CDI

at Christiana Care Health System in Newark, Delaware, United States

Job Description

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.



-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




-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:

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.


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.

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Job Posting: 858029

Posted On: Oct 14, 2021

Updated On: Nov 13, 2021