Senior Manager, Clinical Documentation Integrity, Clinical Licensure-Risk Adjustment

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.

• 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.