Senior Manager, Clinical Documentation Integrity, Clinical Licensure

Kaiser Permanente; Pasadena (CA); On-site; USD 150,000 - 190,000; Full time

Job summary

Kaiser Permanente in Pasadena, CA is seeking a CDI Director to lead clinical documentation review programs, mentor staff, and ensure accurate coding and SOI/ROM indicators across markets.

The role drives CDI process improvements, analyzes data, conducts audits, and partners with medical leadership to deliver compliant, high-quality documentation while meeting regulatory standards.

Qualifications

• Minimum six (6) years of experience in an inpatient acute care or clinical setting.
• Minimum one (1) year of experience managing operational or project budgets.
• Minimum five (5) years of experience in a leadership role with or without direct reports.
• Minimum four (4) years of experience in clinical documentation improvement or integrity.

Responsibilities

• Creates and advocates for developmental opportunities for others; builds collaborative, cross-functional relationships.
• Manages designated units or teams by translating business plans into tactical action items; oversees the completion of work assignments and identifies opportunities for improvement.
• Oversees clinical documentation reviews by performing quality assurance reviews of medical/health records and overseeing the scheduling and coverage of medical/health record reviews to promote the accuracy and completeness of clinical documentation.
• Drives the improvement of clinical documentation processes by analyzing reports to ensure the CDI program is effectively improving accuracy and completeness, and leading data/root cause analyses.
• Drives staff training and education by overseeing CDI trainings and partnering with medical leadership.
• Oversees regulatory compliance by outlining procedures for documenting clinical information in line with regulatory requirements and managing audits.

Skills

Health care coding

Quality improvement

Data analysis

Root cause analysis

Project management

Regulatory compliance

Written communication

Data quality

Health information systems

Education

Bachelor's degree in Nursing, Medicine, Health Administration, Health Information Management, or related field

Nurse Practitioner Certificate (California) or RN/PA/MD license (California) required at hire

Tools

Epic System

Job description

Job Summary:

Oversees clinical documentation reviews by performing quality assurance reviews of medical/health records and overseeing the scheduling and coverage of medical/health record reviews to promote the accuracy and completeness of clinical documentation, and providing mentorship and serving as an expert resource within a market or markets for applying and documenting medical codes and diagnostics-related groups to accurately capture diagnoses. Drives the improvement of the clinical documentation improvement/integrity (CDI) program by leading data and root cause analyses and reviewing reports to identify improvement opportunities in CDI processes. Oversees regulatory compliance by managing audits of clinical documentation to ensure compliance with coding guidelines and federal regulations, and leading the resolution of cases of non-compliance. Drives staff training and education by overseeing training and establishing partnerships between the CDI team and medical leadership to facilitate and promote CDI trainings.

Essential Responsibilities:

• Creates and advocates for developmental opportunities for others; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; works with leaders and employees to set goals and provide open feedback and coaching to drive performance improvement. Pursues professional growth; hires, trains, and develops talent for growth opportunities; strategically evaluates talent for succession planning; sets performance management guidelines and expectations across teams / units. Oversees implementation, adapts, and stays up to date with organizational change, challenges, feedback, best practices, processes, and industry trends; shares best practices within and across teams. Fosters open dialogue amongst team members, engages, motivates, and promotes collaboration within and across teams; motivates teams to meet business objectives. Delegates tasks and decisions as appropriate; provides appropriate support, guidance and scope; encourages development and consideration of options in decision making; fosters access to stakeholders.
• Manages designated units or teams by translating business plans into tactical action items; oversees the completion of work assignments and identifies opportunities for improvement; ensures all policies and procedures are followed; partners with key stakeholders and business leaders to ensure products and/or services meet requirements and expectations while aligning with departmental strategies. Aligns team efforts; builds accountability for and measuring progress in achieving results; assumes responsibility for decision making; fosters direct reports to resolve escalated issues as appropriate. Communicates goals and objectives; incorporates resources, costs, and forecasts into team and unit plans; ensures matrixed resources are fulfilling service or performance requirements across reporting lines. Removes obstacles that impact performance; identifies and addresses improvement opportunities; guides performance and develops contingency plans accordingly; influences teams and units to operate in alignment with operational and business objectives.
• Oversees clinical documentation reviews by: performing quality assurance reviews of medical/health records and overseeing the scheduling and coverage of medical/health record reviews to promote the accuracy and completeness of clinical documentation; ensuring identified omissions or contradictions in medical records are rectified efficiently; providing mentorship and serving as an expert resource within a market or markets for applying and documenting medical codes and diagnostics-related groups (DRGs) to accurately capture diagnoses; overseeing the review of records to promote the accuracy of identification and documentation of the presence of medical conditions that impact severity of illness (SOI) and risk of mortality (ROM) indicators; and reviewing clinical documentation improvement/integrity (CDI) query data and processes to facilitate accuracy and efficiency in the resolution of open queries.
• Drives the improvement of clinical documentation processes by: analyzing reports to ensure the CDI program is effectively improving the accuracy and completeness of clinical documentation and documentation issues are efficiently resolved; leading the performance of data and root cause analyses to identify trends and improvement opportunities in clinical review and documentation processes; and overseeing market operations to ensure productivity and quality standards are achieved and driving the implementation of CDI process improvement initiatives.
• Drives staff training and education by: overseeing training and establishing partnerships between the CDI team and medical leadership to facilitate and promote CDI trainings; and serving as an expert resource for clinical documentation education/training programs.
• Oversees regulatory compliance by: outlining procedures for documenting clinical information in line with regulatory requirements; managing audits of clinical documentation to facilitate compliance with coding guidelines and federal regulations; leading the resolution of cases of non-compliance; and identifying needs and opportunities across the CDI team to maintain up-to-date knowledge of relevant regulations.

Minimum Qualifications:

• Minimum six (6) years of experience in an inpatient acute care or clinical setting.
• Minimum one (1) year of experience managing operational or project budgets.
• Minimum five (5) years of experience in a leadership role with or without direct reports.
• Minimum four (4) years of experience in clinical documentation improvement or integrity.
• Bachelors degree in Nursing, Medicine, Health Administration, Health Information Management, or related field AND minimum eight (8) years of experience in nursing, medicine, CDI, inpatient coding, quality review, case management, or directly related field OR Minimum eleven (11) years of experience in nursing, medicine, CDI, inpatient coding, quality review, case management, or a directly related field.

• Nurse Practitioner Certificate (California) required at hire OR Registered Nurse License (California) required at hire OR Physician Assistant License (California) required at hire OR Doctor of Medicine License (California) required at hire

Additional Requirements:

• Knowledge, Skills, and Abilities (KSAs): Information Gathering; Written Communication; Audits; Compliance Management; Confidentiality; Health Care Compliance; Maintain Files and Records; Applied Data Analysis; Data Quality; Data Stewardship; Health Care Data Analytics; Technical Documentation; Execution Excellence; Health Care Coding; Relationship Building; Coordination; Managing Complexity; Project Management; Service Focus; Autonomy; Curriculum Development; Disease Classification; Internal Audit Processes; Medical Terminology; Medical Coding; Health Care Quality Standards; Employee and Physician Safety; Health Information Systems; Quality Improvement; Quality Assurance and Effectiveness; Health Plan Operations; Government Health Care Programs; Training; Trend Analysis; Root Cause Analysis

Preferred Qualifications:

• Certified Clinical Documentation Specialist Credential (CCDS) from the Association of Clinical Documentation Integrity Specialists (ACDIS) OR Certified Documentation Improvement Practitioner (CDIP), Certified Coding Specialist (CCS), Certified Coding Specialist Physician-based (CCS-P), Registered Health Information Administrator (RHIA), OR Registered Health Information Technician (RHIT) from the American Health Information Management Association.
• Four (4) years of experience using Epic System software OR other Electronic Medical Record (EMR) system.