Job Description

Job Title: Clinical Documentation Improvement (CDI) Manager

Location: Santa Barbara, California (Hybrid) - Relocation Assistance Available

Schedule: Monday - Friday, 8:00 am - 5:00 pm

Compensation: $135,300 - $202,900 - Depending on experience

Overview:

We are seeking a skilled and motivated CDI Manager to lead our Clinical Denials and Appeals team. This role is responsible for managing utilization review processes, ensuring accurate patient status designation (inpatient/outpatient), and improving clinical documentation practices to support revenue integrity.

The ideal candidate is a Registered Nurse with medical coding experience and a strong understanding of utilization review, clinical appeals, and healthcare documentation standards.

Key Responsibilities:

• Oversee utilization review to ensure accurate patient status across the system.
• Collaborate with providers to improve documentation and support status determinations.
• Build and enhance EMR tools to optimize the UR and CDI processes.
• Manage and report on clinical denials and appeals, identifying trends and opportunities for improvement.
• Lead educational initiatives for staff and providers to prevent denials and enhance compliance.
• Analyze denial categories and implement corrective actions to reduce revenue loss.
• Support revenue cycle operations with clinical insight and strategic recommendations.
• Participate in the Utilization Review Committee and contribute to performance reporting.

Qualifications:

Education: Bachelor’s degree required.

Licensure: Active RN license required; must obtain California RN license upon hire if not already licensed.

Experience:

• 3+ years in utilization review or case management in an acute care setting
• 2+ years in a supervisory role (can overlap with the above)
• Medical coding experience required
• Preferred: 2 years of direct RN patient care in acute care

Technical Skills:

• Proficiency with InterQual, Milliman guidelines, EMR systems, and Microsoft Office
• Strong analytical and reporting skills
• Preferred: Experience with revenue cycle processes

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