Job Description

JOB SUMMARY:
NEW POSITION AND REMOTE OPPORTUNITY

The Clinical Documentation Integrity Manager oversees the daily operations of the Carle Health CDI program which is inclusive of staff activities, data collection, analysis and reports in order to meet organizational goals. In conjunction with the HIM Director the CDI Manager ensures the quality, accuracy and timeliness of the CDI process and outcomes. This position is responsible for monitoring and optimizing case mix index, mortality and severity of illness metrics for Carle facilities and any required reporting for these metrics as well as monitoring compliance with regulatory requirements. The CDI manager assures consistent workflow with concurrent review of inpatient hospital encounters by hiring, training and maintaining sufficient staffing to meet program objectives. The CDI Manager partners with the HIM physician advisors and medical staff leaders to identify education needs and develop education for providers related to clinical documentation integrity and the DRG system. Additionally, this position works in tandem with the hospital Coding Manager to assure DRG coding is accurate, coding queries are managed, and education is provided to the coding team related to CDI. The CDI Manager also partners with other Revenue Cycle leaders to trend and respond to inpatient denials as appropriate.

EDUCATIONAL REQUIREMENTS
Bachelor's Degree in Nursing

CERTIFICATION & LICENSURE REQUIREMENTS
Registered Professional Nurse (RN) License Illinois upon hire.

EXPERIENCE REQUIREMENTS
At least three (3) years nursing management experience in an acute care setting and/or managing a CDI program PLUS 1-3 years working experience as a CDI nurse reviewer/specialist. AndAt least 1 year experience in an inpatient care setting.

SKILLS AND KNOWLEDGE
Knowledge of official coding and clinical documentation guidelines. Familiarity with automated computerized encoders and software, billing systems, medical records, and DRGs. Knowledge of standard CDI workflow and query process. Strong organizational planning, scheduling and project management skills. Ability to work with a diverse team from many different departments. Excellent communication skills both orally and in writing. Excellent analytical and critical thinking skills in order to identify trends and act on data to recommend solutions and performance improvement opportunities. Excellent problem solver, collaborator and clinical acumen.

ESSENTIAL FUNCTIONS:

• Manage the CDI team including but not limited to: hiring, training, managing and evaluating team performance and conducting professional development plans.
• Ensure productivity and accuracy standards are met and support overall department and Carle organizational goals.
• Assist Director in budgeting for the CDI department.
• Collect, analyze and present data and solutions related to CDI team performance, provider performance, query outcomes and documentation issues across Carle.
• Develop and execute CDI process improvement projects.
• Collaborate extensively with HIM physician advisors, Carle medical staff, vendors and coding leadership to provide data and solutions to further Carle's objectives related to the CDI program.
• Oversees the development and implementation of ongoing formal and information education of the medical staff, coders, CDI, and other staff as needed related to CDI topics.
• Reviews and develops policies and procedures to support compliant CDI workflows.
• Develops reports as needed and communicates CDI metrics to internal and external teams as needed.
• Works with software vendor and external consulting groups to ensure software efficacy, as well as, ensuring integrity of the data from these teams and software applications, and to ensure vendor is compliant with contractual obligations.
• Participates in and leads multidisciplinary teams to develop and implement best practices in Clinical Documentation Improvement.
• Provides feedback to Director of Coding and CDI on exceptional and substandard CDI performance as needed.
• Provides support and guidance in all Carle Experience and Carle Behavior Standards initiatives.

• Presents CDI metrics as requested or required at department and external meetings.
• In conjunction with the coding managers evaluates ongoing requirements for coding and DRG assignment yearly.
• Provides support of and guidance in all Carle Experience and Carle Behavior Standards and Initiatives.