Clinical Documentation Integrity Manager (DH0262)

POSITION SUMMARY

The Clinical Documentation Integrity (CDI) Manager is responsible for the development, implementation and ongoing maintenance of the CDI department and team. The position manages and oversees the daily operations of the department activities and staff, data collection, analysis and reports to meet department and organizational wide goals. CDI Manger is responsible for providing CDI program oversight and day-to-day implementation and management of processes related to the concurrent review of the clinical documentation in the inpatient medical record. This includes, but is not limited to, overall responsibility for the planning, administration, control, and quality management of CDI Department activities in addition to regular reporting of department progress and initiatives to hospital leadership. Also, responsible for supporting the denials: management team in responding to clinically related denials and downgrades and overseeing the provider enrollment function. The position requires excellent critical thinking skills; knowledge of IPPS and related medical record documents; broad-based clinical knowledge and thorough understanding of pathophysiology; as well as the ability to adapt to changes in the workload, to work independently and to effectively prioritize work assignments. The position requires in-depth of knowledge of CDI process, workflow management and electronic health records. The position requires a high degree of collaboration with clinicians, health care providers, patient financial services, quality, and coding leadership. This position is eligible for telework with supervisor approval and upon a successful training/trial period. Teleworker must have a reliable and adequate internet connection with a minimum 20Mbps internet speed. Should a minimum internet speed not be met, or the teleworker’s internet is unstable, work must be performed onsite. Teleworkers using personal virtual desktop must use on VMware Horizon 7 to conduct their work off-site. Teleworkers assigned a TCRHCC laptop must use a VPN to connect to internal resources to conduct their work off-site. Teleworkers are responsible for complying with all applicable TCRHCC policies (Telework Policy and Procedures, Remote Access, and the Telework Agreement).

NECESSARY QUALIFICATIONS

Education:

Bachelor’s in nursing, health administration or related field (Foreign nursing or medical degree is acceptable if evaluated and deemed equivalent to U.S. standards by a recognized credentialing agency)

Certification:

Must have a valid, current, full and unrestricted Professional Nursing License to practice nursing in any state of the United States of America, The Commonwealth of Puerto Rico, or a territory of the United States

Experience:

Two (2) years of progressively responsible leadership experience in Clinical Documentation Integrity, nursing, case management, or related healthcare field

Other Skills and Abilities:

• Knowledge of Coding and Clinical Documentation Guidelines.
• Familiarity of automated/computerized encoders, groupers, abstracting, database, billing systems, medical records.
• Proven/demonstrated skills in use of encoder grouping and abstracting software.
• Excellent leadership ability with a high level of service delivery.
• Demonstrated initiative with ability to prioritize work, meet deadlines and adapt to changing situations.
• Work independently, be self-directed and contribute as a leading member of a team.
• Proficient with Microsoft Office applications —Excel, Outlook, Power Point and Word.
• Knowledge of the principles and practices of supervision as applied to the management and direction of personnel.
• Strong organizational, planning, scheduling and project management abilities.
• Ability to clearly present information in writing and in presentation form.
• Excellent oral and written communication skills.
• Excellent analytical ability to develop and analyze data to recommend solutions and solve complex problems.
• Maintain variable work schedule to meet department needs. (evenings, holidays, weekends and limited travel).
• Ability to ensure a high level of customer satisfaction including employees, patients, visitors, and other departments within TCRHCC.
• Completion of and above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job.
• Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job.
• Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job.
• Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading or incomplete information, as determined by TCRHCC.

ESSENTIAL FUNCTIONS

Operational Leadership

1. Lead and manage the CDI program, ensuring the highest standards of documentation accuracy, completeness, and compliance.
2. Support the denials management team in responding to clinically related denials and downgrades
3. Lead and manage the provider enrollment function ensuring accuracy, completeness, and compliance.
4. Assists CDI team with daily inpatient reviews within 24- 60 hours of admission and throughout hospitalization to: 

• • evaluate documentation that supports the coder’s assignment of the reason for admission and/or etiologic diagnosis, principal diagnosis, and comorbidities and complications that support the CMG/DRG/PDPM.
  • document, review details in the EHR for physician notification and response.

1. Manage the CDI staff including but not limited to hiring, training, managing & evaluating team performance and conducting professional development plans.
2. Ensure that the productivity and actions of the CDI team meet and support the overall operational goals of the department and organization.
3. Fully support the denials management team in responding to clinically related denials and downgrades including serving as subject matter expert on denial rationales and identify primary downgrade issues.
4. Assist Director with development of annual budget for CDI.
5. Collect, analyze and present data related to CDI team performance, provider performance, query outcomes and documentation issues (prepare options, present recommendations, and explain associated benefits and risks)
6. Develop and execute CDI process improvement projects (department and organization wide)
7. Oversees the development and implementation of ongoing formal and informal education of physicians, mid-levels, nursing and other qualified clinical staff.
8. Collaborate extensively with physicians, nurses, and other healthcare providers to improve clinical documentation processes and promote accurate representation of patient conditions and treatment plans.
9. Represents the CDI program at meetings and committees.
10. Acts as a consultant to providers, management, administration and billing staff regarding documentation, coding, and reimbursement and compliance matters.

Learning and Development

1. Design, develop and execute standard policies and procedures, standardized queries, technologies and tools, and strategies targeted to improve the quality of documentation and overall quality and financial performance of TCRHCC..
2. Participate and lead multidisciplinary teams to develop and implement best practices in Clinical Documentation Improvement.
3. Participate in and promote the prevention, detection and resolution of instances of non-compliance with institutional wide CDI policies
4. Provide feedback to the coding team and clinicians on exceptional and/or substandard CDI performance as needed.
5. Train new employees to department policies and procedures.
6. Complete performance evaluations.
7. Counsel CDI team on actions required to meet minimum performance requirements.
8. Provides or arranges for necessary knowledge-based resources required by the CDI staff to meet quality and production standards.
9. Counsel CDI team on actions required to meet minimum performance requirements.
10. Provides or arranges for necessary knowledge-based resources required by the CDI staff to meet quality and production standards.

Strategic Relationships

25. Develops and strengthens collaborative relationships with stakeholders to advance the care of our patients
26. Actively encourages collaboration and possesses excellent interpersonal skills in building and maintaining crucial relationships
27. Delivers information in a clear, concise and compelling manner
28. Delivers targeted and actionable communications that invites two-way professional communication; adjust messages appropriately by audience
29. Demonstrates a willingness and ability to assist others