Executive RN Director of Utilization Management and CDI
healthcarerecruitmentpartners.comGainesville, GA, United States14 hours ago
Job type
- Full-time
Job descriptionMaster's Degree in Nursing or other health related field preferred Oversees Utilization Management working closely with Case Management and other members of the interdisciplinary team to ensure effective collaboration for length of stay and throughput Communicate with and educate physicians and other key stake holders regarding Utilization Review policies, practices, and procedures to ensure safe, effective services, along with appropriate transitions of care Assesses departmental workload to determine appropriate staff allocations to ensure productivity standards are being met consistently Oversee day-to-day operations of the Utilization Management Department, ensuring compliance with payer requirements and regulatory standards Oversee and manage the CDI department to ensure ongoing accuracy, completeness, and specificity of clinical documentation Work closely with case management, managed care, and patient financial services to streamline utilization review and enhance hospital financial performance Monitor and analyze key performance indicators (KPIs), financial goals, and length of stay (LOS) metrics to drive performance improvements Recruit, train, and manage a high-performing CDI and UM team, ensuring operational alignment with hospital objectives Manage departmental budgets, ensuring financial responsibility and resource allocation Develop and implement performance metrics to evaluate team effectiveness and drive continuous improvement Foster strong relationships with internal and external stakeholders, including hospital executives, physicians, and payers Provide data-driven insights and strategic recommendations to hospital leadership regarding CDI and UM performance Act as the operational leader for process improvement initiatives related to documentation, utilization management, and revenue cycle optimization Work closely with Physician Advisors to develop and revise policies and procedures related to clinical status determination, medical necessity, clinical documentation, denials and appeals, and physician education Provides education to operational leaders, staff and Physicians on the importance of the Clinical Documentation Improvement Program (CDIP), and works cooperatively with them to ensure that improved documentation is seen as part of the strategic mission of the Organization Facilitate modifications to clinical documentation through extensive concurrent interactions with Physicians, nursing staff, case managers, and coding team to ensure that appropriate reimbursement and severity of illness (SOI) is captured Coordinates, comply with and share data reflecting the activity associated with the Documentation Program on an on-going basis highlighting key performance indicators Act as operational leader for Clinical Documentation Improvement Initiative with The Advisory Board to achieve "best practice" across the System, partnering with the medical staff, including Hospital employed Physicians and independent Physicians providers in the community Review daily, weekly and monthly reports to monitor and analyze performance of UM and CDI departments, assess data against KPI standards and goals, and identify trends to make adjustments as indicated Works closely with physicians and staff to provide and monitor clinical / financial data for the purpose of improving hospital / physician performance and anticipating payer and managed care demands Actively participates as the operational leader for UM and CDI in committees including but not limited to MRUR; Compliance; Policy and Procedures; and Quality Identifies and maintains good relationships with other departments such as Managed Care, Patient Financial Services, Patient Access, and others so to facilitate the utilization review processes and to provide continuity of care
RN Executive Director of Utilization Management and CDI
Gainesville, GA
As the Executive Director of Utilization Management / CDI, you’ll lead efforts to connect clinical excellence with financial strength. In this role, you’ll oversee Utilization Management and Clinical Documentation Integrity to ensure accurate documentation, appropriate resource use, and strong reimbursement outcomes. You’ll work closely with physicians, hospital leadership, and cross-functional teams to reduce denials, improve Case Mix Index (CMI), and support quality patient care. If you’re a collaborative leader who thrives on driving both clinical and operational success, this is the opportunity to make a lasting impact.
Qualifications :
- Registered Nurse license required
- Bachelor's Degree in Nursing required
- Director of Utilization Management and CDI experience combined in an Acute Hospital Setting, with progressive Revenue Cycle leadership experience required
- Utilization Management specific certification preferred (CCM, ACM, CPUR) preferred
CDI / coding certification preferred
Responsibilities :
To apply for Case Management opportunities or to inquire further, interested individuals can directly contact Michelle Boeckmann at Michelle@HCRecruiter.com or visit our Case Management website at
Feel free to share these contact details with anyone who might be interested in Case Management and Utilization Management opportunities.
Michelle Boeckmann | President Case Management Recruitment
Direct Dial 615-465-0292
America's Best Professional Recruiting Firms | Forbes 2025
Top 10 U.S. Search Firm – Executive Search Review
A member of the Sanford Rose Associates® network of offices
Create a job alert for this search
Utilization Management Rn • Gainesville, GA, United States
Related jobs
As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations.
As the facility leader, you will be part of a close-k...Show moreLast updated: 30+ days ago
DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day.
As a Dasher, you’ll stay busy with a var...Show moreLast updated: 30+ days ago DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day.
As a Dasher, you’ll stay busy with a var...Show moreLast updated: 30+ days ago DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day.
As a Dasher, you’ll stay busy with a var...Show moreLast updated: 30+ days ago 
The Phoenix at Lake Lanier is seeking an RN / LPN to join their team as a Wellness Director!.The Wellness Director is responsible for providing overall leadership and management of the health and wel...Show moreLast updated: 5 days ago
Director of Recruitment and Community Engagement.Located in the fastest-growing region of the state, the University of North Georgia is a multi-campus university with an enrollment of nearly 20,000...Show moreLast updated: 13 days ago
Experience the advantages of real career change.Join Piedmont to move your career in the right direction.Stay for the diverse teams you’ll love, a shared purpose, and schedule flexibility tha...Show moreLast updated: 4 days ago Director, Equal Opportunity Office (EOO) / Title IX Coordinator.About the University of Georgia : .Since our founding in 1785, the University of Georgia has operated as Georgia’s oldest, most comprehen...Show moreLast updated: 30+ days ago Associate Dean / Director of Movement Science.Located in the fastest-growing region of the state, the University of North Georgia is a multi-campus university with an enrollment of nearly 20,000 stud...Show moreLast updated: 30+ days ago Regional Director of Development.About the University of Georgia : .Chartered by the state of Georgia in 1785, the University of Georgia is the birthplace of public higher education in America and is...Show moreLast updated: 30+ days ago Director of Academic Integration.About the University of Georgia : .Chartered by the state of Georgia in 1785, the University of Georgia is the birthplace of public higher education in America and is...Show moreLast updated: 23 days ago 
Overview : .Do what you love, and love what you do! When the work you do every single day has a crucial impact on the lives of others, every effo...Show moreLast updated: 5 days ago
DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day.
As a Dasher, you’ll stay busy with a variety o...Show moreLast updated: 10 hours ago DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day.
As a Dasher, you’ll stay busy with a variety o...Show moreLast updated: 10 hours ago DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day.
As a Dasher, you’ll stay busy with a var...Show moreLast updated: 30+ days ago Associate Director of Governmental Training, Education, and Development Division.About the University of Georgia : .Since our founding in 1785, the University of Georgia has operated as Georgia’s old...Show moreLast updated: 30+ days ago 
ADN Healthcare is seeking a travel nurse RN OR - Operating Room for a travel nursing job in Cumming, Georgia.Job Description & Requirements.
Our Client is currently seeking OR - Operating Room f...Show moreLast updated: 12 days ago
TravelNurseSource is working with AMN Healthcare to find a qualified Home Health RN in DAHLONEGA, Georgia, 30533!.Job Description & Requirements.
Registered Nurse – Home Health - Travel - (HH R...Show moreLast updated: 15 days ago
- Promoted
Dialysis Clinical Manager Registered Nurse - RN
Fresenius Medical CareGainesville, Georgia, USFull-time
- Promoted
Restaurant Delivery - Sign Up in Minutes
DoorDashDahlonega, GA, United StatesFull-time +1
- Promoted
Restaurant Delivery - Onboarding / Onboard
DoorDashDahlonega, GA, United StatesFull-time +1
- Promoted
Delivery Driver - Sign Up and Start Earning
DoorDashDahlonega, GA, United StatesFull-time +1
- Promoted
Wellness Director
The Phoenix At Lake LanierGainesville, GA, USFull-time
- Promoted
Director of Recruitment and Community Engagement
InsideHigherEdDahlonega, Georgia, United StatesFull-time +1
- Promoted
RN - ICU
Piedmont Healthcare Inc.Snellville, GA, USFull-time
- Promoted
Director, Equal Opportunity Office (EOO) / Title IX Coordinator
InsideHigherEdAthens, Georgia, United StatesFull-time +1
- Promoted
Associate Dean / Director of Movement Science
InsideHigherEdDahlonega, Georgia, United StatesFull-time +1
- Promoted
Regional Director of Development
InsideHigherEdAthens, Georgia, United StatesFull-time +2
- Promoted
Director of Academic Integration
InsideHigherEdAthens, Georgia, United StatesFull-time +2
- Promoted
RRT - NICU, PRN
Piedmont Healthcare Inc.Snellville, GA, United StatesFull-time
- Promoted
- New!
Restaurant Delivery - Sign Up and Start Earning
DoorDashCornelia, GA, USFull-time +1
- Promoted
- New!
Dashers - Sign Up and Start Earning
DoorDashDahlonega, GA, USFull-time +1
- Promoted
Restaurant Delivery - Start Earning Quickly
DoorDashDahlonega, GA, United StatesFull-time +1
- Promoted
Associate Director of Governmental Training, Education, and Development Division
InsideHigherEdAthens, Georgia, United StatesFull-time +1
- Promoted
Travel Operating Room RN
ADN HealthcareCumming, GA, USPermanent
- Promoted
Travel Registered Nurse (RN) - Home Health (HH) - $1,992 to $2,195 per week in Dahlonega, GA
TravelNurseSourceDAHLONEGA, GA, USFull-time