Clinical Documentation Intergrity Manager

Valleywise Health; Phoenix (AZ); Hybrid; USD 105,000 - 155,000; Full time

Job summary

Valleywise Health in Phoenix, AZ, seeks a Clinical Documentation Integrity Manager to lead inpatient and outpatient CDI teams in a hybrid environment. You will manage staff, drive quality, and partner with HIM leadership to improve documentation and financial outcomes.

Requirements include RN licensure in AZ or compact state, CCDS/CDIP certification, EPIC and 3M experience, and 10+ years clinical experience with 5 in CDI and 2 in supervisory roles.

Qualifications

• Requires a BSN or MSN (or equivalent) with nursing licensure.
• Five years CDI experience with at least two in supervision.
• Ten years direct clinical experience.

Responsibilities

• Oversee daily CDI program operations and training.
• Ensure HCC capture accuracy and RAF alignment.
• Lead CDI initiatives across inpatient and outpatient settings.
• Develop policies and ensure compliance with AHIMA/AAPC standards.
• Monitor productivity and quality metrics.

Skills

Leadership

Education program development

Auditing & reporting

HCC/RAF tracking

Education

BSN or MSN or equivalent

Tools

EPIC EHR

3M Encoder

Microsoft Office

Job description

Clinical Documentation Intergrity Manager

Utilizing a hybrid work environment, under the direction of the HIM Director, the CDI Manager provides clinical and administrative leadership to the inpatient and outpatient CDI teams. Responsible for staff management and development, quality, service excellence, workplace experience and financial outcomes. Partners with organizational leadership to achieve goals to improve provider documentation.Assumes accountability as delegated by the HIM Director.

Annual Salary Range: $105,164.80 - $155,126.40

Qualifications
Education:

• Requires a Bachelor of Science in Nursing or a master’s degree in Medicine; or an equivalent combination of training and progressively responsible experience that will result in the required specialized knowledge and abilities to perform the assigned work.

Experience:

• Required: Five (5) years of experience in clinical documentation improvement including at least two (2) years of supervisory/managerial level activity.
• Required: Minimum of ten (10) years direct clinical experience required.

Specialized Training:

• Required: Hands-on Experience with EPIC Electronic Health Record & 3M encoder and Microsoft Office software.

Certification/licensure:

• Required: Current licensure to practice as a Registered Nurse in the State of Arizona or compact state licensure
• Required: Valid driver’s license
• Required: Professional certification in Clinical Documentation (CCDS or CDIP)
• Preferred: Professional Certification (CRC)
• Preferred: Coding Credentials (CCS, CCS-P, CPC, CIC, COC) or RHIA, RHIT certification is also accepted with requisite coding experience
• Preferred: Dual credentials

Knowledge, Skills, and Abilities:

• Manages daily CDI program oversight to include productivity, quality, education and training, auditing, report management, performance improvement initiatives and developing standardized practices, processes as well as policies and procedures.
• Manages and reports risk adjusted Hierarchical Condition Category (HCC) capture rate and Risk Adjustment Factor (RAF) accuracy in alignment with managed care contracts, particularly Medicare Advantage plans. Tracks/ trend metrics and, on occasion, presents CDI program compliance and progress related to capturing HCC diagnoses to physicians.
• Advocates for facilitating the best practice model for CDI, linking the most accurate capture of documented bedside care to the most accurate numeric reporting codes thereby, conversion into correct reporting, facility and physician profiling and acuity capture.
• Audit documentation quality to support accurate statistics and reimbursement for the inpatient and outpatient CDI program.
• Maintain a clear working knowledge of the CDI technology tool regarding data entry, report generation and tracking methods to ensure the most efficient use of the tool.
• Approves CDI time sheets, completes performance evaluations, develops team member performance improvement plans if necessary and monitors compliance learning module completion.
• Acts in a leadership capacity with key areas for initiatives such as: DRG Downgrade Denials, State Fair Hearing Appeals, PSI reporting, Physician education, ICD-10 preparedness, and implementation.
• Assists in development of policies and procedures for system-wide CDI practices to meet Corporate Compliance guidelines and to ensure appropriate and effective reimbursement.
• Must have a high level of understanding of computer applications, Microsoft Office (Excel, Word, PowerPoint, and Outlook), Electronic Health Records, and encoder systems.
• Must be able to abide by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and AAPC.
• Must have the analytical ability necessary to interpret clinical data contained in records and to assign appropriate codes.
• Must have the ability to show initiative and utilize critical thinking skills to provide potential solutions to problems identified.
• Proficient in developing and presenting education programs
• Must be able to communicate effectively and have excellent customer service skills.
• Requires the ability to work well independently and demonstrate independent decision-making abilities.
• Ability to analyze and prioritize work efforts and organize and coordinate multiple functions and tasks.
• Requires the ability to read, write and speak effectively in English.
• Requires the ability to work both remotely and onsite in the ambulatory clinics and Inpatient Acute Hospital.
• Utilizes a personal vehicle to routine travel to assigned ambulatory clinic sites to provide formal and informal education to ambulatory clinic providers.