Medical Director - Clinical Documentation Integrity

NorthShore University HealthSystem

Evanston (IL)

On-site

USD 205,000 - 237,000

Full time

4 days ago

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Job summary

The Medical Director, Inpatient Clinical Documentation Integrity at Endeavor Health System leads the enterprise CDI program across all sites, ensuring complete and accurate records that support appropriate reimbursement and quality reporting. The role partners with CDI leaders and medical staff to advance documentation practices and maintain high standards of care.

This is a 0.75 FTE, full-time commitment with Monday–Friday daytime hours, some off-hour coverage, and requires travel.

Qualifications

MD or DO from an accredited medical school is required.
Five+ years post-residency with at least two years in a physician advisor role.
Active board certification in a relevant clinical specialty is required.
CDI and physician advisor experience with second-level review, denials and appeals preferred.
AHIMA or ACDIS CDI certifications preferred/not required at hire.

Responsibilities

Performs expert second-level reviews of complex cases, including documentation validation and DRG determinations.
Partners with CMOs and physician leaders to drive education and adoption of best documentation practices.
Serves as subject matter expert for the acute care CDI program to physicians and APPs.
Maintains CDI physician advisor program operations, workflows, HR practices and reporting.
Leads enterprise CDI strategy, standardizes practices across sites, and guides system-wide direction.
Oversees CDI performance metrics with leaders and supports scorecard targets.
Leads education and response to audits, denials and appeals with stakeholders.
Advances education and technology to meet financial and quality targets.
Promotes ethical, compliant query/documentation practices per AHIMA/ACDIS/AHA CMS standards.

Skills

Collaboration and teamwork

Conflict resolution

Written and verbal communication

Analytical and problem solving

Leadership and team development

Time management

Education

MD or DO from an accredited medical school

Leadership/quality management training

Tools

Epic

CDI software

Power BI

Vizient CDB

Microsoft Office

Job description

Position: Medical Director, Inpatient Clinical Documentation Integrity
Location: Endeavor Health Systemwide role
Full Time - 0.75 FTE commitment
Hours: Monday-Friday, day time hour. Some flexibility required for off-hour coverage
Required Travel: Yes
Salary range: [$148.68/hr. -$172.00/hr.]

Qualifications:

Minimum Education Level

Required: MD or DO from an accredited medical school
Preferred: Additional post-graduate training in quality, management and/or leadership.

Minimum Licensure Requirements

Required: MD or DO from an accredited medical school
Preferred: Additional post-graduate training in quality, management and/or leadership.

Minimum Certification Requirements

Required: Active Board certification in a relevant clinical specialty.
Preferred: Active Physician advisor certification, either from the American College of Physician Advisors certification (ACPA-C) or the ABQAURP Physician Advisor certification (CHCQM-PHYADV), held at hire or achieved within six months of start.
CDI-focused certification from AHIMA or ACDIS

Minimum Work Experience

* Required: 5+ years of post-residency practice and at least 2 years of experience in a physician advisor role with escalating leadership responsibilities in a healthcare setting.

* Prior experience in a CDI and physician advisor role and including second-level review, denials, appeals, and clinical validation.

Job Summary

The Medical Director, Inpatient Clinical Documentation Integrity (CDI) is an enterprise role providing physician leadership for the Inpatient CDI program across the entire Endeavor Health system. The position is accountable for a complete and accurate health record that tells the true story of each patient's clinical condition and the care provided, a critical function that ensures accurate reimbursement, appropriate risk adjustment for quality measures, and the validity of reported quality outcomes. Partnering with CDI operational leaders in a dyad model, this role sets enterprise CDI strategy and serves as the senior physician voice for the program, engaging medical staff, quality, and revenue cycle to advance shared documentation goals across all hospitals. Current scope encompasses acute care CDI system-wide, with accountability for CDI across additional care settings within scope as assigned. The Medical Director of Inpatient CDI embodies Endeavor Health's values of kindness, teamwork, excellence, and ownership, leading as a collaborative and approachable partner who holds a high bar for the program and takes personal accountability for its outcomes.

This role carries full-system, multi-site responsibility and is a 0.75 FTE commitment and reports to the Vice President of Clinical Documentation Integrity.

Responsibilities and Essential Functions

* Performs expert second-level and escalation reviews of complex, disputed, or high-impact cases, including clinical validation, query disagreements, and CC/MCC and DRG determinations, serving as the system's final physician resource for documentation integrity and does so in line with existing Endeavor Health policies and procedures. (20%)

* Partners with hospital Chief Medical Officers (CMOs), CDI and other physician leaders across the enterprise to drive medical staff education, engagement, and adoption of documentation best practices within their standard templates. (15%)

* Serves as the subject matter expert and the face of the acute care CDI program to physicians and advanced practice providers, leading enterprise education and providing individualized provider feedback on documentation patterns and query response. (15%)

* Maintains the operations of the CDI physician advisor program, including the operating model, relevant workflows and expectations, HR practices, and program reporting. (10%)

* Leads enterprise CDI physician strategy across all Endeavor Health sites, partnering with CDI operational leaders to set system-wide direction and standardize practice for the care settings within scope. (10%)

* Oversees enterprise CDI performance and metrics with operational and entity leaders, supports scorecard target setting, and develops physician advisor and CDI team capability. (10%)

* Leads the enterprise clinical response to documentation-related audits, denials, and appeals from regulatory bodies and payers, including DRG and clinical validation matters, in collaboration with relevant stakeholders. (10%)

* Advances education, new technology and organizational process to achieve financial and quality targets, improve physician engagement, and establish and maintain a high performing program. (5%)

* Promotes ethical, compliant query and documentation practices consistent with AHIMA, ACDIS, AHA Coding Clinic and CMS regulatory standards across the system. (5%)

Knowledge, Skills and Abilities:

Clinical documentation integrity principles and how a complete and accurate record drives accurate reimbursement, risk adjustment, and quality outcome reporting, including AHA coding clinic guidelines, MS-DRG and APR-DRG assignment, severity of illness, and risk of mortality adjustments, Vizient risk calculators, and others
Clinical validation, query integrity, and compliant documentation practices consistent with AHIMA and ACDIS standards.
Healthcare regulations, payer requirements, and revenue integrity practices.
Performance improvement principles and methodologies, such as the Model for Improvement from the Institute for Healthcare Improvement (IHI)
Change management principles and methodologies such as Prosci ADKAR Model.

Skills

Collaboration and teamwork skills, with a track record of building trust and working effectively across disciplines and hospitals
Conflict resolution and de-escalation skills, particularly in disputed or high-stakes clinical discussions.
Strong written and verbal communication skills.
Analytical and problem-solving skills, with the ability to interpret data and identify trends.
Leadership and team development skills.
Organizational and time management skills.

Abilities

Leads with kindness and emotional intelligence, fostering a culture of psychological safety and mutual respect.
Maintains composure, sound judgment, and a steady, professional demeanor in high-pressure or contentious situations.
Demonstrates a collaborative, approachable presence that engages physicians and teams as partners.
Sets and upholds a high standard for documentation integrity and program performance, continuously raising the bar.
Takes personal accountability for program outcomes and follows through on commitments across the enterprise
Establishes credibility and leadership presence with physicians, executives, and frontline teams across the enterprise.
Ability to influence and build trust with physicians and stakeholders across clinical and administrative departments.
Ability to lead and align work across a complex, multi-hospital system.
Ability to manage multiple priorities in a fast-paced environment.
Demonstrates professionalism, integrity, and sound judgment, and maintains confidentiality.

Technical Skills

* Electronic health record systems, prior work and knowledge of Epic a plus

* CDI software and computer-assisted coding tools.

* Data analytics and reporting and visualization tools, including Microsoft Power BI (PBI) and Vizient Clinical Database (CDB)