RN CDI Quality Management Specialist

Kootenai Health; Coeur d'Alene (ID); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Employer-paid medical benefits

Dental insurance

Vision insurance

Tuition assistance

Retirement plan with employer match

Shift differentials

Wellness program

PerkSpot discounts

Employee referral bonus

Job summary

Kootenai Health in Idaho is seeking a Clinical Documentation Improvement Specialist to enhance accuracy and completeness of provider documentation. You will work with CDI leadership, physicians, coding, and billing teams to identify opportunities for improvement and to ensure high-quality data for profiling and reporting.

The role requires 5+ years in acute care and CDS experience, with CDIP/CCDS certification.

Qualifications

• Bachelor’s degree in nursing required; Master’s preferred.
• State of Idaho RN license or pending licensure as documented by temporary licensure or current RN licensure in a multi-state compact prior to start.
• Minimum 5 years’ acute care clinical experience.
• 3 years’ clinical documentation specialist experience.
• CDIP or CCDS certification required.
• Quality/leadership background preferred.

Responsibilities

• Explain complications, severity of illness, and risk of mortality (MCC/CC, SOI, ROM) and their impact on DRG calculations.
• Demonstrate self-direction, analytical teaching, and clear verbal and written communication.
• Perform retrospective reviews of inpatient coding and medical records focusing on quality metrics and denial prevention.
• Compose compliant queries to providers to obtain documentation clarification.
• Educate clinicians and staff on query workflows, CDI concepts, coding guidelines and quality concepts.
• Utilize software to collect, track and report outcomes, analyze data, and prepare improvements for KH quality metrics.
• Participate in quality committees as needed.
• Mentor new CDS staff on quality concepts and coding guidelines.
• Back up for concurrent, retrospective, and denial reviews.
• Maintain regular attendance and complete mandatory training.

Skills

Nursing expertise

Clinical documentation

Leadership

Query guidance

Education

Bachelor’s degree in nursing

Master’s degree preferred

Job description

• Department Transitional Care Services - Clinical Documentation

Position Summary

Facilitates the improvement of the overall quality, completeness and accuracy of provider-based clinical documentation in the medical record. Performs retrospective reviews in Hospice, Mortality, Clinical Validity, Risk Adjustment and other quality concepts such as PSI, HAC and re-admission. Functions in a fast paced and continuously evolving department, working collaboratively with physician advisors, leadership within coding and billing, and other departments. Works directly with Clinical Documentation Integrity (CDI) leadership, but has the ability to function independently utilizing guidance provided.

Responsibilities

• Demonstrates ability to understand and explain complications and comorbidities (MCC/CC), severity of illness (SOI) and risk of mortality (ROM), mortality variables, case mix index (CMI), chronic and secondary conditions (HCC), impact of procedures, DRG calculation and imparts this knowledge to CDI staff, providers, and members of the healthcare team
• Performs with self-direction, independent decision-making, analytical teaching, and articulate communication skills, both verbal and written
• Performs retrospective review, analyzing the inpatient coding and medical record to identify coding opportunities and gaps in documentation, with a focus on quality variables such as mortality, readmission, risk adjustment, PSI, HAC, and denial prevention
• Composes compliant queries to providers to obtain clarification of the documentation, following compliant query practice guidelines
• Serves as a resource and participates in the ongoing education of clinicians and staff relating to physician query workflows, basic clinical documentation improvement concepts, coding guidelines and quality concepts, both written and verbal, to ensure that clinical information utilized in profiling and reporting is complete and accurate
• Accurately utilizes software systems to collect, track and report outcomes and maintain integrity of data collection. Analyzes data, creates reports, presentations and provides recommendations for process improvement to improve KH quality metrics to leadership
• Attends and participates in quality related committees as necessary
• Assists primary preceptor in fostering new CDS staff members on basic quality concepts, query compliance, daily workflows and coding guidelines as needed
• Assists and backs-up for concurrent, retrospective, and denial reviews
• Relies on experience and judgment to plan and accomplish goals
• Regular and predictable attendance is an essential job function
• Completes mandatory training requirements
• Performs other related duties as assigned
• Familiar with standard concepts, practices, and procedures within the field
• Competent to meet age specific needs of the unit assigned

Requirements and Minimum Qualifications

• Bachelor’s degree in nursing required; Master’s preferred
• State of Idaho Registered Nurse OR licensure pending as documented by temporary licensure OR current RN licensure from a state participating in the “multistate privilege to practice” compact with Idaho prior to start date
• Minimum 5 years’ acute care clinical experience required
• 3 years’ clinical documentation specialist experience required
• Certified Documentation Improvement Practitioner (CDIP) or Certified Clinical Documentation Specialist (CCDS) required
• Quality and/or leadership background preferred

Working Conditions

• Must be able to lift and move up to 20 lbs
• Must be able to stoop or crouch
• Must be able to reach arms above or below shoulder height
• Must be able to maintain a standing and/or sitting position
• Typical equipment used in a clinical job

About Kootenai Health:

Kootenai Health is a highly esteemed healthcare organization serving patients throughout northern Idaho and the Inland Northwest. We have been recognized with many accolades and distinctions, including being a Gallup Great Workplace, No. 1 Best Place to Work in Large Healthcare Organizations, and Magnet Status for Nursing Excellence. We pride ourselves on our outstanding reputation as an employer and a healthcare provider.

As your next employer, we are excited to offer you:

• Comprehensive medical coverage, including fully employer-paid options for eligible full‑time employees, plus affordable plans for part‑time staff.Benefits begin on the 1st of the month following 30 days of employment.
• Dental, vision, life, and pet insurance, with telemedicine and wellbeing resources available to all employees
• Tuition assistance after 90 days to support your professional growth
• Retirement plans with pre‑tax and Roth options and employer matching from 3%–6%
• Competitive pay, plus night, weekend, and PRN shift differentials
• Award‑winning wellness program with coaching, financial wellness resources, and free or discounted access to fitness centers and premium wellbeing apps
• PerkSpot discountsproviding access to thousands of exclusive deals in over 25 categories
• And an employee referral bonus program

Kootenai Health provides exceptional support for extraordinary careers. If you want to work on a high-quality, person-centered healthcare team, we can't wait to meet you!

Kootenai Health complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, veteran status, or sex. Kootenai Health does not exclude people or treat them differently because of race, color, national origin, age, disability, veteran status, or sex.

Why I love my job as a Nurse at Kootenai Health

A variety of medical, dental, and vision insurance plans are available to both full and part‑time employees, with some available at no cost to the employee. In addition, benefit-eligible employees also gain access to the following:

• Tuition assistance and career development programs
• Robust Retirement Plan
• Night, weekend and PRN shift differentials

This is a snapshot of your potential career path highlights the series of job positions that help you progress towards your goals and objectives. Ultimately, your career path depends on your career values and personal goals.

Success Profile

What makes a successful nurse at Kootenai Health?