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group
Category
Management & Supervision
business
Department
Clinical Documentation Improvement
date_range
Schedule
Full Time
schedule
Shift
Day
timer
Hours
8 Hour Shift
place
Location
Rancho Mirage, CA 92270
info
Job #
R0260192
  • Job Objective: A brief overview of the position.
    • Under the direction of the Director of Case Management/Social Services/Clinical Documentation Integrity, the Clinical Documentation Improvement Manager is responsible for providing concurrent documentation review, DRG and coding reviews that ensure high quality documentation that supports a compliant and accurate representation of the care provided to the patient.  The Manager will be responsible for organization, daily oversight of processes, and monitoring and management of all members of the Clinical Documentation Integrity (CDI) team
  • Reports to
    • Director, Case Management/Social Services
  • Supervises
    • Clinical Documentation Integrity (CDI) team
  • Ages of Patients
    • Pediatric
    • Adolescent
    • Adult
    • Geriatric
  • Blood Borne Pathogens
    • Minimal/ No Potential
  • Qualifications
    • Education
      • Required: BSN
      • Preferred MSN
    • Licensure/Certification
      • Required: Active California RN license
      • Preferred: CCDS,CCS, RHIT, ICD-10 AHIMA training certification or equivalent
    • Experience
      • Required: A minimum of 5 years recent clinical nursing experience in an acute care setting
      • Required: Minimum of 3-5 years supervisory or management experience in CDI
      • Preferred: Knowledge of MS-DRG methodology and inpatient coding rules and regulations
  • Essential Responsibilities
    • Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
    • Oversight and management of department operations and personnel.
      • Assure division of total daily workload among Clinical Documentation Specialists (CDSs) to provide equal share of patient census, complexity of work, and ability to complete assignment
    • Monitoring of daily process for all team members, to include:
      • Effective time management for completion of assignment
      • Adequate data entry to reflect all pertinent patient data
      • Support of all ICD-10 codes assigned
      • Solid clinical support for physician queries
      • Completion of physician query data
      • Follow-up of cases
    • Facilitation of communication between inpatient coder designee and CDI team
      • Resolution of DRG mismatches
      • Appropriate elevation of unresolved DRG mismatch cases to Coding Manager or designee
    • Regularly scheduled meetings between coding staff and CDI team
      • Discussion of complex cases
      • New coding rules and regulations
    • Reconciliation of all CDS charts
      • DRG mismatches
      • Communication with Coding Manager and CDI Director of case and resolution as necessary
      • Accurate recording of CDS impact on record
        • Financial
        • SOI
        • New clinical information in literature
    • Collaboration in planning, analysis, procedure changes, scheduling and related administrative duties
      • Assists Case Management Director:
        • With development of policies and procedures for current practice
        • With development of future state policies and procedures
        • With staff evaluations
    • Facilitation of issue identification and resolution
      • Recognition and reporting of team conflict
      • Instant notification to CDI Director for issues that require immediate intervention
      • Investigation of all facts to determine necessary steps to resolve conflict
    • Individual team member or group CDI counseling to address issues, if directed by CDI Director
    • Effective communication to team and to administration regarding any barriers to success identified within the CDI department
    • Management of staffing to ensure appropriate allocation and compliance with goals and objectives.
    • Coverage of absent CDS floor assignments
    • Audit of CDS cases
      • Compliant query writing
      • Accuracy in ICD-10 code assignment
      • Accuracy in Principle Diagnosis identification
      • Accuracy in all appropriate secondary diagnosis capture
      • Accuracy in reconciliation
      • Review of all cases with DRG mismatch for effective and timely resolution
    • Monitoring and reporting of quality and financial performance in collaboration with Strategic Services Associate.
      • Staff performance reports
        • Productivity
        • Physician Query percentage
        • Physician Query response rates
        • Physician Query agreement rates
      • Physician dashboard
      • Administrative reports
        • Financial benefit
        • Case Mix Index
    • Assurance of compliance with government health regulations, JCAHO guidelines, CMS quality requirements and customer service standards.
    • Assist with design and recommendation of enhancement and cost saving strategies.
      • Routine, timely assessment of CDI opportunity for financial impact and accurate reflection of CMI
        • Expansion to other MS-DRG payers
        • Coverage of new service line if applicable
        • Assessment of team metrics for appropriateness
        • Number of new reviews per day
        • Number of case follow-ups per day
        • Average number of physician queries per day
        • Accuracy in query completion
    • Resolution of interdepartmental issues to ensure consistency in quality, procedure, and policy application.
    • Regularly scheduled CDI department meetings.
      • Communication of new administrative information to the CDI team
      • Communication to CDI Director
        • Team dynamics affecting departmental performance
        • Barriers to success
        • Educational needs
        • Team concerns
    • Development, monitoring and implementation of programs to enhance customer service, develop skills and improve scope of service for all CDI team members.
      • Participation in nursing unit rounds
      • Physician education
      • Clinical specialty education for all team members
    • Participation in meetings and relevant committees as assigned by Director.
    • Identification of opportunities for intradepartmental and interdepartmental operational improvements.
    • Reporting of CDI metrics to organization leadership to demonstrate impact of the program:
      • CDS productivity
      • Physician query rate
      • Physician response rate
      • Physician agreement rate
      • Physician CMI
      • Financial impact
    • Maintenance of accurate records of review activities to comply with departmental and regulatory agency guidelines.
    • Performance of other duties as assigned.