Clinical Documentation Integrity (CDI) Manager
Who we are:
At Lifepoint Health, we provide quality healthcare to rural communities. As a valued member of our team, you will be an integral part of a group working together to elevate Lifepoint's healthcare delivery network. Our network includes 60+ community hospitals, 60+ rehabilitation/behavioral health hospitals, and 250 additional sites of care across the United States. As an organization, we are dedicated to serving communities nationwide by providing exceptional care. We believe in the power of our talented teams and strive to create environments where employees find purpose and fulfillment.
What you’ll do:
As a CDI Manager, you will direct the activities of the Clinical Documentation Integrity (CDI) program for their assigned facilities. The CDI Manager is responsible for providing CDI program oversight and day-to-day implementation and management of processes related to the concurrent review of the clinical documentation in the inpatient medical record. This includes, but is not limited to, overall responsibility for the planning, administration, control, and quality management of CDI Department activities in addition to regular reporting of department progress and initiatives to hospital leadership. This position also provides oversight to the DRG Downgrade Appeals Specialist team.
Responsibilities:
· Oversee the operations and human resource needs of the CDI and DRG Downgrade team for assigned facilities.
· Direct and maintain adequate staffing and workflow to meet CDI and DRG Downgrade team’s needs.
· Monitor various reports and productivity to ensure that production standards and objectives are met in areas of responsibility.
· Lead the CDI program as demonstrated by assuming accountability for the ongoing success of the Clinical Documentation Integrity and DRG Downgrade Programs.
· Monitor CDI program and communicate with appropriate facility leadership regarding CDI key performance indicators (KPIs) and identifies and implement process changes to maintain and improve KPIs.
· Develop and execute appeals management strategies for the DRG downgrade team.
· Develop and monitor key DRG Downgrade KPIs.
· Assure appropriate action is taken within appeal time frames to address DRG downgrade denial.
· Serve as subject matter expert on denial rationales and identify primary downgrade issue.
· Provide feedback and coaching to staff on well written appeal arguments based on clinical evidence within the medical record and evidence-based literature.
· Ensure appeals follow current industry clinical guidelines, evidence based medical, community and national medical management standards and protocols.
· Systematically analyze problems, draw relevant conclusions and devise appropriate courses of actions based on denial and overturn data.
· Provide clinical support for producing high quality, timely, and effectively written appeals.
· Engage and consult with Physician Advisor and/or CMO to resolve provider issues regarding answering clarifications and participation in the clinical documentation improvement process.
· Serve as a resource to Physicians / Case Managers and other key professional staff in matters relating to clinical documentation improvement & ICD-10.
· Work with medical records, quality, finance, and physician groups to develop systems to facilitate complete documentation for data reporting purposes.
· Develop and monitor strategic operating goals, objectives, and budget; and reports operational performance, justification and/or corrective action.
· Develop and manage direct reports; and oversees the development and management of indirect reports.
· Build and maintain productive inter/intra departmental and vendor work relationships to optimize operations.
· Ensure Clinical Documentation Integrity education for providers & new staff and new initiatives or identified areas of knowledge deficit. Track and trend program compliance to determine areas of focus for educational opportunities.
· Design and implement education programs which provide education for CDI staff
· Develop and ensures ongoing CDI education for new staff is delivered
· Report program progress/operations to hospital leadership on a monthly basis.
· Maintain regular and reliable attendance.
· Perform other duties as assigned.
What you’ll need:
Education: Nurse (RN, NP, or graduate of a state approved nursing program), or Physician (MD, DO, FMG), or Physician Assistant (PA)
Experience:
· Minimum of 5 years of CDI experience in an acute inpatient setting
· Minimum of 2 years of direct management experience
· Prior Leadership of people and projects
· Strong Analytical skills (with CDI metric related focus)
· 3+ years of Excel experience
· Experience with CAC technology preferred
Certifications: CCDS or CDIP certification; CCS Certification preferred
Why choose us:
As a team member of the Health Support Center, our goal is to support those that are in our facilities who are interfacing and providing care to our patients and community members. Our focus is to attract, retain, and empower a diverse and determined workforce. Our mission statement is at the heart of who we are and what we do: “Making Communities Healthier.” In this shared mission, we believe that our collective efforts will shape a healthier future for the communities we serve.
Benefits: We offer an excellent total compensation package, including a competitive salary and benefits. Some of our benefits include 401k, flexible PTO, generous Employee illness benefit (EIB), medical, dental, vision, tuition reimbursement, and an Employee Assistance Program. We believe that happy, healthy people have a passionate engagement with life and work and have designed our package to enhance your wellbeing.
Equal opportunity and affirmative action employers and are looking for diversity in candidates for employment: Minority/Female/Disabled/Protected Veteran