Manager Clinical Documentation Integrity RN

MyMichigan Health; Midland (MI); On-site; USD 115,000 - 155,000; Full time

Job summary

MyMichigan Health seeks a Manager of Clinical Documentation Integrity to lead CDI programs across the system, driving accurate MS-DRG/APR-DRG assignment, Severity of Illness, and Risk of Mortality with HCC-based risk adjustment. The role oversees CDI specialists and coders, delivering education and analytics to secure appropriate reimbursement and quality tracking.

The candidate will mentor staff, collaborate with clinical teams, and develop IP/AMB CDI processes; prior leadership and CMS

Qualifications

• 1-3 years CDI leadership experience
• Minimum of five years of current hospital CDI program experience
• Thorough knowledge of CMS regulations including coding guidelines, DRG reimbursement, and Risk adjustment (HCC/RAF)
• Demonstrated knowledge of Hospital Acquired Conditions and quality indicator codes (e.g., PSI, PPI)
• Excellent written and verbal communication skills for cross-functional interaction
• Experience with IP and AMB CDI software applications

Responsibilities

• Maintains current knowledge of MS-DRG system, CCs/MCCs, impact on quality and CMI; ensures compliant query practices
• Understands risk-adjusted payment methodologies and collaborates with providers on coding and billing
• Promotes collaborative, high-functioning teams with clear metrics and mentoring
• Educates providers and healthcare team on clinical documentation; engages physicians to improve participation
• Develops IP and AMB CDI programs, processes, policies, and provider education; performs data analysis for improvement
• Performs CDI reviews during high-volume periods to support program goals

Skills

CDI leadership

MS-DRG/APR-DRG

HCC risk adjustment

CMS regulations

Provider education

Data analytics

Education

Bachelor's degree

Master's degree

Tools

CDI software

IP/AMB CDI tools

Job description

Summary

Candidates must have a primary address located within the state of Michigan or willing to move to Michigan to be considered.

To be part of our organization, every employee should understand and share in the MidMichigan Health Vision, support our Mission, and live our Values. These values include excellence, integrity, teamwork, and accountability and must guide what we do as individuals and professionals.

The Manager of Clinical Documentation Integrity provides strategic leadership, daily operational direction, and continuous evaluation for both the Inpatient and Ambulatory Clinical Documentation programs across the healthcare system.

This role bridges acute-care clinical outcomes to include MS-DRG/APR-DRG assignment, Severity of Illness, and Risk of Mortality with ambulatory risk adjustment model - Hierarchical Condition Categories to include HCC capture facilitating appropriate risk adjustment and reimbursement. The Manager supervises a split or cross-functional team of CDI Specialists/HCC coders, leading system-wide provider education, data analytics, and compliant workflows to secure appropriate reimbursement, risk adjustment and clinical quality tracking.

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES

(25%) Maintains current knowledge of the MS-DRG system, CCs/MCCs, impact on quality, risk of mortality, severity of illness and CMI as well as ICD-10 coding systems and guidelines related to Clinical Documentation Integrity to include formulation, standardization, and enforcement of compliant query practices adhering to AHMIA and ACDIS coding and documentation standards

(25%) Understands risk adjusted payment methodologies, HCC assignment and payment methodology along with professional coding and billing, outpatient facility coding and billing, and OPPS reimbursement methodology and shares this knowledge with colleagues and clinical team member to ensure interdisciplinary collaboration and revenue integrity

(25%) Promotes collaborative, high-functioning teams through clear communication, shared success metrics and mentoring staff

(25%) Communicates with and educates providers and all other members of the healthcare team regarding clinical documentation and monitors provider participation. Ensures that direct reports communicate, educate and engage with physicians and other members of the healthcare team regarding clinical documentation. Other Duties and Responsibilities: Development of IP and AMB CDI programs to include department processes, policies, staff education, and provider education to include presentations to department, provider practices, and individual providers education (to include new provider education) Data analysis to identify trends and opportunities for improvement: PEPPER Reports, Mortality, Readmission etc. Denials and appeals management – oversight of process and utilization of case information to drive provider education Perform CDI reviews as required to support program during high volumes Staff Development to include precepting new staff, audits, and focused individual/group education Leads and/or actively participates in meetings. Actively participates in department performance improvement and employee engagement activities. Performs all other duties or special projects requested by leadership and proactively communicates any problems that arise to maintain the smooth operation of the department. Exhibits enthusiasm for the profession, embraces educational opportunities and department support offered and remains engaged in the goals and the vision of the department. Role models the professional standards of behavior and encourages all staff to do the same.

Certifications and Licensures

RN: Registered Nurse

NIMS IS 100: NIMS IS 100 Introduction Incident Command System

Within 6 months of hire or transfer

NIMS IS 700: NIMS IS 700 Introduction National Incident Mgt System

Within 6 months of hire or transfer

NIMS IS 200: NIMS IS 200 Basic Incident Command System Initial Response

Within 6 months of hire or transfer

CCDS: Certified Clinical Documentation Specialist

In Lieu of CCDS will accept Certification of Clinical Documentation Specialists Outpatient (CCDS-O)

Required Education

Bachelor's degree is required

Masters degree preferred

Other Information

EXPERIENCE, TRAINING AND SKILLS

1-3 years of CDI leadership experience to effectively lead a team.

Minimum of five (5) years of current hospital clinical documentation improvement program experience is required.

Must have thorough knowledge of CMS regulations to include coding guidelines, DRG reimbursement, and Risk adjustment to include HCC/RAF coding and documentation requirements.

Demonstrated knowledge of state and federal Hospital Acquired Conditions (HAC) and other applicable quality indicator codes (i.e. PSI, PPI, etc.).

Written and verbal communication skills necessary to interact successfully with individuals and groups at levels of the organization in order to share ideas, concepts, and actions in a clear and understandable manner.

Demonstrate expertise with IP and AMB CDI software applications.

Mandatory tuberculosis (TB) testing must be done annually.

Mandatory Occupational Safety and Health Administration (OSHA) training must be completed annually according to the Exposure Control Plan.

MyMichigan Health is a technology driven organization and employees need to demonstrate competency in Microsoft® Windows. An employee may be required to participate in further learning opportunities offered by MyMichigan Health.

Physical/Mental Requirements and Typical Working Conditions

Exposure to stressful situations Able to wear personal protective equipment that includes latex materials or appropriate substitute if required for your position. Is able to move freely about the facility with or without an assisted device and must be able to perform the functions of the job as outlined in the job description. Overall vision and hearing are necessary with or without assisted device(s). Frequently required to sit/stand/walk for long periods of time. Ability to handle multiple tasks, get along with others, work independently, regular and predictable attendance and ability to stay awake. Overall dexterity is required including handling, reaching, grasping, fingering, and feeing. May require repetition of these movements on a regular to frequent basis. Physical Demand Level: Sedentary. Physical Demand Level: Light. Must be able to occasionally (0-33% of the workday) lift or carry 11-20 lbs., frequently (34-66% of the workday) 10 lbs. and or Walk/Stand/Push/Pull of Arm/Leg controls