Interim CDI/Utilization Manager

Warbird Consulting • Lima, OH

390d

About The Position

Warbird Healthcare Advisors actively seeks experienced consultants to be considered for an Interim CDI & Utilization Manager role with a health system in Ohio. The successful candidate will facilitate and obtain appropriate physician documentation for any clinical conditions or procedures to support the appropriate severity of illness, expected risk of mortality, and complexity of care of the patient. This position works with third-party payers and within payer reimbursement systems to help manage care, not only through pre-authorization, but additionally through the continuum of care in the health system.

Requirements

• Graduate of an accredited school of nursing, BSN required.
• Valid unrestricted license with the Ohio Board of Nursing.
• Minimum of three (3) years clinical experience, including experience in dealing with and conversing with physicians, required.

Nice To Haves

• Certification in case management and/or utilization review preferred.

Responsibilities

• Participates in the analysis and trending of statistical data for specified patient populations to identify opportunities for improvement.
• Assists with preparation and presentation of clinical documentation monitoring/trending reports for review with physicians and hospital leadership.
• Educates members of the patient care team regarding specific documentation needs and reporting and reimbursement issues identified through daily and retrospective documentation reviews and aggregate data analysis.
• Facilitates change processes required to capture needed documentation, such as forms redesign.
• Partners with the coding professional to ensure accuracy of diagnostic and procedural data and completeness of supporting documentation to determine a working and final DRG, severity of illness, and/or risk or mortality.
• Reviews and clarifies clinical issues in the health record with the coding professionals that would support an accurate DRG assignment, severity of illness, and/or risk of mortality.
• If review of record is post-discharge, conducts review within the hospital's billing timeframe.
• Assists in the denial process by reviewing denied claims, writing appeals and supplying supporting documentation.
• Connects the roles of utilization management with clinical documentation and makes recommendations to director for improvement in both areas.
• Performs internal audits of both UM and CDI to be presented at the hospital's Compliance Meeting. Areas of audit include but not limited to CMI increase through query process, lost days or dollars due to overutilization of resources, etc.
• Manages and directs duties of the UM technical assistant in their role regarding the duties above.
• All other duties as required.

What This Job Offers

• Career Level: Mid Level
• Industry: Professional, Scientific, and Technical Services
• Education Level: Bachelor's degree
• Number of Employees: 101-250 employees