Director of Case Management / Utilization Management / CDI

Director of Case Management / Utilization Management / CDI

$130,000–$156,000 | Full Benefits | EPIC EMR

Location: Janesville, OH | Employment Type: Full-Time (Onsite)

About the Opportunity

A nationally recognized hospital in East-Central Ohio is seeking an experienced Director of Case Management / Utilization Management / Clinical Documentation Integrity (CDI) to lead a high-performing team across inpatient and emergency services.

This role is ideal for a seasoned healthcare leader who excels in care coordination, medical necessity review, clinical documentation, reimbursement integrity, and interdisciplinary collaboration. You will oversee 50–60 Case Managers, Social Workers, UM Nurses, and CDI Specialists and directly influence patient flow, care quality, compliance, and financial performance.

If you’re passionate about improving care across the continuum—and want to lead in an organization that values excellence, integrity, and team collaboration—this is an exceptional next step.

Compensation & Benefits

• Salary: $130,000–$156,000 (based on experience)
• Full medical, dental, vision & retirement benefits
• Paid time off extended illness bank
• Professional development & leadership advancement support
• Relocation considered case-by-case
• EPIC EMR environment with strong operational resources

What You Will Lead

Case Management

• Oversight of inpatient & ED case managers
• Safe, timely discharge planning
• Length-of-stay (LOS) management
• Coordination with nursing, physicians & post-acute partners

Utilization Management

• Medical necessity reviews & level-of-care determinations
• Prior authorization & payer communication
• Denial prevention and appeals
• Physician Advisor program oversight

Clinical Documentation Integrity

• Documentation accuracy to support coding quality
• DRG validation & reimbursement compliance
• Collaboration with HIM, coding & revenue cycle teams

Key Responsibilities

• Direct daily operations for CM, UM, and CDI teams
• Optimize throughput, discharge processes, LOS, and readmission metrics
• Lead performance improvement initiatives using data-driven decision making
• Oversee denial management, appeals, and payer relationship strategies
• Partner with medical staff leadership to ensure clinical documentation accuracy
• Ensure compliance with CMS, QIO, and internal quality standards
• Support population health, value-based care, and system-wide care management initiatives
• Maintain reporting, dashboards, analytics, and departmental performance indicators
• Mentor, develop, and empower departmental leaders and frontline staff
• Serve on hospital committees and represent the department in cross-functional initiatives

Qualifications

Required:

• Master’s degree in Nursing, Healthcare Administration, Business Administration, or related field
• Active RN license (Ohio or multistate compact)
• Minimum 3 years of leadership in Case Management, UM, or CDI
• Expertise in:
• Discharge planning & care transitions
• Medical necessity criteria (InterQual/MCG)
• Clinical documentation accuracy
• Prospective payment systems & managed care
• Mid-revenue cycle, coding workflows & quality metrics
• Demonstrated experience leading multidisciplinary teams
• Strong data analysis and performance improvement skills

Preferred:

• Certified Case Manager (CCM)
• Experience in EPIC EMR
• Background in denial management, LOS reduction, and throughput optimization

Why This Role Is Unique

• You’ll inherit a strong, stable team—position opened due to retirement, not turnover
• Leadership genuinely values collaboration, quality, and innovation
• Highly visible role with significant organizational impact
• Opportunities to shape strategy for CM, UM, and CDI programs hospital-wide
• Work in a supportive, mission-driven environment with advanced technology and robust clinical teams

Apply Now

If you’re an experienced RN leader with deep expertise in Case Management, UM, or CDI—and you’re ready to take on a strategic, high-impact role—we’d love to connect with you.

Job Type: Full-time

Pay: $130,000.00 - $150,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Relocation assistance
• Vision insurance

Education:

• Master's (Required)

Experience:

• Leadership Experience in Case Management, UM, or CDI: 3 years (Required)

License/Certification:

• RN License (Required)
• RN License in the state of OH (Preferred)

Location:

• Zanesville, OH 43701 (Preferred)

Ability to Relocate:

• Zanesville, OH 43701: Relocate with an employer provided relocation package (Required)

Work Location: In person

Salary : $130,000 - $156,000