Manager-utilization Mgmt/clinical Documentation
Company: Covenant Healthcare
Posted on: June 1, 2021
8:00 AM - 4:30 PM, MONDAY - FRIDAY
FULL TIME BENEFITED
The Clinical Manager of the Utilization Management and Clinical
Documentation Improvement (UM/CDI) Department assists with
overseeing the daily operations of the UN/CDI department. This
position oversees the Utilization Review Nurses and Clinical
Documentations Improvement Specialists. Utilization Management is
responsible for ensuring compliance with regulatory requirements
for the appropriateness and medical necessity of care provided.
Clinical Documentation Improvement reviews the medical record to
ensure accurate and complete clinical documentation, working with
providers using a query-based system. The Manager provides the
input to the Director of Revenue Cycle regarding daily strategic
decisions that affect the functional areas of the department.
Demonstrates excellent customer service performance in that
his/her attitude and actions are at all times consistent with the
standards contained in the Vision, Mission and Values of Covenant
HealthCare and the commitment to Extraordinary Care for Every
- Serves as immediate manager for Utilization Review and Clinical
Documentation Improvement staff at the facility.
- Responsible for daily operational management, supervision of
staff, budget preparation and monitoring, and other management
- Accountable for strategic planning, implementation, evaluation,
and revision of systems that support UM/CDI department and
- Maintains 24-hour accountability for his/her area
- Assists with developing and implementing UM/CDI programs and
daily scheduling of all staff.
- Evaluates and assesses patient care data to ensure that care is
provided in accordance with CMS Conditions of Participation and
clinical guidelines by ensuring staff are using appropriate and
Covenant HealthCare endorsed tools that meet organizational
- Responsible to provide leadership and direction in the daily
operational activities of UM and CDI functions by assuring that
activities are appropriately assigned, resources are available, and
requirements of external entities such as regulatory and
third-party payers are met.
- Ensures that the department objectives and metrics are achieved
timely and on-target according to identified goals, including the
four pillars of success.
- Communicates issues and concerns affecting the department's
capacity to achieve results with the Revenue Cycle leadership and
proactively assists with crafting solutions that will positively
impact identified goals.
- Assigns tasks according to priority and supports in carrying
out activities to reach identified goals.
- Ensures that department needs are identified, analyzed and
responded to in a timely manner.
- Responsible for final oversight of payroll, performance
evaluations and corrective action.
- Perform other duties as assigned.
- Bachelor's Degree required.
- Licensed RN in the State of Michigan required.
- Minimum three (3) years of supervisory/management experience
- Experience in Utilization Management and/or Clinical
Documentation Improvement required.
- Minimum of five (5) years of experience in a patient care acute
- Working knowledge of navigating patients through procedures and
across the continuum of care.
- Experience with continuous performance improvement
- Ability to communicate effectively, both written and verbal
communication, with persons of various cultural and educational
backgrounds, including patients, families, staff, leadership and
- Demonstrates knowledge of utilization review and clinical
- Maintains professional development through seminars, workshops,
in-service activities and current professional literature
- Excellent organizational skills and ability to effectively
coordinate all aspects of patient care.
- Ability to be an active, participatory member the
- May be required to participate in on-call activities after
hours and weekends.
- Full command (written and verbal) of the English language.
WORKING CONDITIONS/PHYSICAL DEMANDS
- Ability to maintain regular, punctual attendance consistent
with the ADA, FMLA and other federal, state and local
- Frequent walking, sitting, talking, and hearing.
- Occasional lifting, standing, carrying, pushing, pulling,
climbing, stooping, reaching, handling, and fingering.
- Occasional near vision, midrange vision, far vision, color
vision, and field of vision.
- Occasional lifting 0-50 lbs.
NOTICE REGARDING LATEX SENSITIVITY IN APPLICANTS FOR
It has been determined that Covenant HealthCare cannot provide a
latex safe or latex free work environment at any of its facilities.
Unfortunately, that means that any individual, including an
applicant or an employee, is likely to be exposed to latex while on
Covenant's premises. Therefore, latex tolerance is considered to be
an essential function for any position with Covenant.
Keywords: Covenant Healthcare, Saginaw , Manager-utilization Mgmt/clinical Documentation, Other , Saginaw, Michigan
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