Senior Director, Clinical Optimization & Risk

WVU Medicine; Wheeling, Northern (WV, KY); Hybrid; USD 150,000 - 230,000; Full time

Job summary

WH Wheeling Hospital Inc. is seeking a Director of Clinical Optimization to lead initiatives that improve SOI, ROM, CMI, HCC capture, and risk adjustment across inpatient, outpatient, and population health settings.

The role bridges CDI, Coding, Quality, Population Health, Finance, and IT to ensure accurate documentation that supports quality outcomes, value-based reimbursement, and regulatory compliance.

Qualifications

• Bachelor of Science degree in Nursing or related healthcare field required.
• Current Registered Nurse license issued by the state or multi-state license via eNLC.
• Obtain Basic Life Support certification within 30 days of hire.
• Seven years of progressive healthcare leadership.
• Experience in CDI, Coding, Quality Improvement, Population Health, Value-Based Care, Physician Engagement, Clinical Documentation, and Hospital Operations.
• Master’s degree preferred; CCDS/CCS/CPC/CPHQ; Lean Six Sigma; CRC certifications are advantageous.

Responsibilities

• Developing and overseeing the Clinical Optimization Program.
• Improve documentation supporting SOI, ROM, CMI, and Length of Stay.
• Partner with CDI and Coding to identify documentation opportunities.
• Standardizing physician documentation best practices across all hospitals.
• Lead Risk Adjustment & HCC initiatives to improve RAF accuracy and chronic disease documentation.
• Collaborate with Population Health, Value-Based Care, and Care Management.
• Partner with Quality teams to improve Vizient metrics and quality indicators.
• Monitor performance metrics like SOI/ROM, observed vs expected mortality, readmission indices.
• Develop executive dashboards and physician engagement strategies.
• Coordinate with IT/Analytics to optimize ambulatory documentation and HCC initiatives.

Skills

Healthcare leadership

CDI collaboration

Quality improvement

Population health

Value-based care

Physician engagement

Clinical documentation

Hospital operations

Education

Bachelor of Science degree in Nursing or related healthcare field

Master’s degree (MSN, MHA, MBA, MPH, or equivalent) preferred

CCDS Certification (Clinical Documentation Specialist)

CCS Certification

CPC Certification

CPHQ Certification

Lean Six Sigma Green Belt or Black Belt

Certified Risk Adjustment Coder (CRC)

Job description

WH Wheeling Hospital Inc. is seeking a Director of Clinical Optimization to lead initiatives that improve SOI, ROM, CMI, HCC capture, and risk adjustment across inpatient, outpatient, and population health settings.

The role bridges CDI, Coding, Quality, Population Health, Finance, and IT to ensure accurate documentation that supports quality outcomes, value-based reimbursement, and regulatory compliance.