Manager of Clinical Documentation Integrity (CDI) & Utilization Review

Logan Health • Kalispell, MT

8d • Onsite

About The Position

Lead with purpose. Support with compassion. Make a system-wide impact! Our Mission: Quality, compassionate care for all. Our Vision: Reimagine health care through connection, service and innovation. Our Core Values: Be Kind | Trust and Be Trusted | Work Together | Strive for Excellence. Logan Health is looking for an RN to lead the way as our Manager of Clinical Documentation Integrity (CDI) & Utilization Review! This role is ideal for a collaborative RN leader who understands the acute care clinical environment, values relationships, and can guide teams and providers through complex workflows with clarity. What You’ll Be Doing: As the Manager of CDI & Utilization Review, you will be responsible for the overall direction, performance, and success of Logan Health’s CDI and UR functions. You’ll work closely with clinical leaders, providers, and interdisciplinary teams to ensure accurate documentation and appropriate utilization. About Our Location: This is an in-person position located within our Logan Health Medical Center at 310 Sunnyview Lane, in beautiful Kalispell, MT. We are in the heart of the Flathead Valley, offering a variety of outdoor recreation and the stunning Glacier National Park. Who You Are: You are a compassionate, steady nursing leader with at least 6 years of acute care experience and excellent clinical skills. You are someone who understands that strong outcomes come from trust, communication, and support. You’re self-directed, approachable, and able to guide both experienced professionals and those who need a little extra reassurance. If you’re looking to use your RN experience to guide teams, support providers, and strengthen clinical documentation and utilization practices, we invite you to apply!

Requirements

• Current Montana RN license or a multi-state compact license with authorization to practice nursing within the state of Montana; required.
• Minimum of three (3) years leadership experience required.
• Minimum of six (6) year’s acute care experience required.
• Extensive knowledge of treatment methodology, patient care assessment, data collection techniques and coding classification systems required.
• Possess broad knowledge of insurance regulations and Medicare/Medicaid guidelines required.
• Possess extensive knowledge of reimbursement systems, federal, state and payer-specific regulations and policies pertaining to documentation and coding preferred.
• Proficient in negotiating complex coding rules and guidelines preferred.
• Advanced clinical expertise and extensive knowledge of complex disease processes with broad based clinical experience in an inpatient setting preferred.
• Excellent organizational skills, detail-oriented, a self-starter, possess critical thinking skills and be able to set priorities and function as part of a team as well as independently.
• Commitment to working in a team environment and maintaining confidentiality as needed.
• Excellent verbal and written communication skills including the ability to communicate effectively with various audiences.
• Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy.
• Possess and maintain computer skills to include working knowledge of Microsoft Office Suite and ability to learn other software as needed.

Nice To Haves

• BSN degree preferred.
• CCDS/CDIP certification preferred, and must be successfully obtained within one (1) year of hire.

Responsibilities

• Providing leadership and oversight for the CDI and Utilization Review teams and programs
• Managing daily workflows to ensure efficiency, consistency, and compliance with organizational goals
• Educating and communicating with providers regarding CDI queries in a professional, collaborative manner
• Partnering with the Chief Medical Officer on utilization review initiatives, length of stay management, and patient throughput
• Ensuring CDI and UR practices align with Logan Health’s philosophy, policies, procedures, strategic goals, budget, and objectives
• Managing staffing schedules, timecard approvals, annual performance reviews, staff education, and corrective actions when needed
• Leading the CDI Committee and actively participating in the Utilization Review Committee
• Supporting continuous improvement, staff development, and a positive team culture
• Manages and coordinates the activities of the CDI and UR department operations.
• Manages the CDI and UR programs.
• Reassigns work, revises processes, workflow, and coordinates between departments as applicable to assigned area(s).
• Responsible for the budget and finances of the CDI and UR programs.
• Assists assigned leadership in providing education to stakeholders on documentation standards, requirements, new state and federal regulations, and services.
• Responsible for the clinical oversight and guidance for all federal audit activity to ensure coding is compliant with regulations and services meet medical necessity.
• Prepares and presents CDI and UR audits to Logan Health Utilization Review Committee per protocol.
• Defines and meets CDI and UR department performance benchmarks.
• Evaluates the performance and effectiveness of staff against benchmarks and works to continuously improve performance and outcomes.
• Provides appropriate levels of coaching to develop individual/team skills and abilities to drive performance improvement.
• Develops and implements policies, procedures and training to guide and support service, and ensures orientation and continuing education for all areas of the assigned area(s).
• Builds a collaborative team culture and ensures a high level of employee engagement and satisfaction.
• Manages and meets the operating and capital budgets for assigned areas and prepares departmental financial, operating and performance variance reports.
• The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job. Not all of the duties may be assigned to a position.

Benefits

• Health, Dental, and Vision insurance
• 401(k) with generous immediate match
• Employer-provided life insurance
• Voluntary life and disability insurance options
• Critical Illness and Voluntary Accident options
• Employee assistance program (EAP)
• FSA
• Paid time off, Holiday pay, and Illness bank
• Employee referral program
• Tuition Reimbursement Program
• Employee Wellness Program that includes wellness coaching, classes, wellness incentives and more
• Logan Health Fitness Center - Waived registration fee and 1/2 off monthly membership due and more!

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 51-100 employees