Executive Director - Case Management, UR, & CDI
Company: Baptist Health Care
Location: Pensacola
Posted on: May 10, 2025
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Job Description:
Job Description
The Executive Director - Case Management, Utilization Review, & CDI
facilitates long-term success of the Utilization Management (UM)
program by providing oversight of UM at the system level. The
position supports the UM program by developing and/or maintaining
effective and efficient processes for determining the appropriate
admission status based on the regulatory and reimbursement
requirements of various commercial and government payers. The
position oversees the case management team, clinical documentation
improvement team, and utilization management team of clinicians,
coding professionals, physicians, and advanced practice providers
to ensure accurate and timely clinical documentation in the medical
record that supports the admission status and coding process in
attaining sound clinical entries in the medical record. Specific
management of care collaboration includes observation utilization
and denial management. The position is responsible for increasing
program awareness (utilization process and program benefits) to the
entire hospital staff. The position must fully understand data
collection and analysis for hospital use of professional services.
The position supports ongoing communication and education on
documentation opportunities, utilization review, coding and
reimbursement issues, as well as performance improvement
methodologies to physicians and entire hospital staff. The
Utilization Management Review Manager functions as the UM Committee
co-chair. The Executive Director works closely with organization
leaders and physicians to identify documentation opportunities
refine processes at the service line level.
Responsibilities
Qualifications
Minimum Education
Minimum Work Experience
Required Skills, Knowledge and Abilities
About Us
Baptist Health Care is a not-for-profit health care system
committed to improving the quality of life for people and
communities in northwest Florida and south Alabama. The
organization includes three hospitals, four medical parks, Andrews
Institute for Orthopaedic & Sports Medicine, and an extensive
primary and specialty care provider network. With more than 4,000
team members, Baptist Health Care is one of the largest
non-governmental employers in northwest Florida.
Baptist Health Care, Inc. is an Equal Opportunity Employer. BHC
maintains and enforces a policy that prohibits discrimination
against any workforce members or applicants for employment because
of sex, race, age, color, disability, marital status, national
origin, religion, genetic information, or other category protected
by federal, state or local law.
Keywords: Baptist Health Care, Pensacola , Executive Director - Case Management, UR, & CDI, Executive , Pensacola, Florida
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