Manager - Clinical Documentation Integrity, Clinical Licensure

Job Summary:

Leads the reviews of applicable cases of medical/health records and manages the scheduling and coverage of medical/health record reviews to promote the accuracy and completeness of clinical documentation, and mentors team members on resolving coding issues to facilitate the accurate capture of diagnoses in medical codes and diagnostic-related groups. Manages the improvement of the clinical documentation improvement/integrity (CDI) program by conducting data and root cause analyses and reviewing reports to identify improvement opportunities in CDI processes. Oversees regulatory compliance by performing audits of clinical documentation to facilitate compliance with coding guidelines and federal regulations, and collaborating with the team and leaders to address cases of non-compliance. Monitors staff training and education by identifying opportunities, developing, and/or leading trainings for medical staff on CDI (e.g., medical review and coding, quality standards, documentation requirements for diagnosis capture).

Essential Responsibilities:

• Provides developmental opportunities for others; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; works closely with employees to set goals and provide open feedback and coaching to drive performance improvement. Pursues professional growth; develops and provides training and development to talent for growth opportunities; supports execution of performance management guidelines and expectations. Leads, adapts, implements, and stays up to date with organizational change, challenges, feedback, best practices, processes, and industry trends. Fosters open dialogue amongst team members, engages, motivates, and promotes collaboration within and across teams. Delegates tasks and decisions as appropriate; provides appropriate support, guidance, and scope; encourages development and consideration of options in decision making.
• Manages designated work unit or team by translating business plans into tactical action items; oversees the completion of work assignments and identifies opportunities for improvement; ensures all policies and procedures are followed. Aligns team efforts; builds accountability for and measuring progress in achieving results; determines and ensures processes and methodologies are implemented; resolves escalated issues as appropriate; sets standards and measures progress. Fosters the development of work plans to meet business priorities and deadlines; obtains and distributes resources. Removes obstacles that impact performance; identifies and addresses improvement opportunities; guides performance and develops contingency plans accordingly; influences teams to execute in alignment with operational objectives.
• Leads clinical documentation reviews by: reviewing applicable cases of medical/health records and managing the scheduling and coverage of medical/health record reviews to promote the accuracy and completeness of clinical documentation; guiding team members to work with medical providers to rectify identified omissions or contradictions in medical records; mentoring team members on resolving complex coding issues to facilitate the accurate capture of medical codes and diagnostic-related groups (DRGs); serving as a resource for identifying and documenting the presence of medical conditions that impact severity of illness (SOI) and risk of mortality (ROM) indicators; and coordinating the resolution of all open clinical documentation improvement/integrity (CDI) queries.
• Manages the improvement of clinical documentation processes by: analyzing reports to ensure the CDI program is effectively improving the accuracy and completeness of clinical documentation and documentation issues are efficiently resolved; conducting data and root cause analyses to identify trends and improvement opportunities in clinical review and documentation processes; and managing daily operations to ensure productivity and quality standards are achieved and recommending opportunities for improvement in CDI processes.
• Monitors staff training and education by: identifying new opportunities, developing, and/or leading trainings for medical staff on clinical documentation improvement (e.g., medical review and coding, quality standards, documentation requirements for diagnosis capture); and offering guidance to the CDI team to develop programs for aligning clinical documentation education/training.
• Oversees regulatory compliance by: providing guidance to CDI team on completing clinical documentation work in line with regulatory requirements; performing audits of clinical documentation to facilitate compliance with coding guidelines and federal regulations; collaborating with the team and leaders to address cases of non-compliance; and coordinating training opportunities to ensure the team has up-to-date knowledge on relevant regulations.