Clinical Documentation Improvement Manager - Remote
hace 3 días
Oceanport
Clinical Documentation Improvement Manager - Remote Full Time, Management, Oceanport, NJ, US Salary Range: $110,000.00 - $120,000.00 Annually Requisition ID: 2414 Why work with us? • A People First Environment: We make what is important to those we serve important to us., • Make an Impact: Enhance the quality of life for seniors., • Professional Growth: Access to training and career development. Competitive Compensation • Medical/Dental, • Generous Paid Time Off, • 401K with Match*, • Life Insurance, • Tuition Reimbursement, • Flexible Spending Account, • Employee Assistance Program Job Summary The Clinical Documentation Improvement Manager is a leadership role responsible for the design, implementation, oversight, and continuous improvement of a comprehensive clinical documentation integrity (CDI) and risk adjustment program within the PACE healthcare model. Ensures that clinical documentation accurately, completely, and compliantly reflects participant acuity, chronic conditions, and clinical complexity to support CMS risk adjustment, quality outcomes, regulatory compliance, and person-centered care planning. The CDI Manager serves as the primary clinical authority for HCCs, ICD-10-CM documentation requirements, and CMS risk adjustment methodology, while building and leading a team that may include certified risk adjustment coders and CDI professionals. Responsibilities Clinical Documentation Integrity & Risk Adjustment Leadership • Lead the organization's CDI and risk adjustment strategy for Medicare Advantage, Medicaid, and PACE full-risk populations., • Serve as the clinical subject matter expert for Hierarchical Condition Categories (HCCs), MEAT/TREAT criteria, and CMS documentation standards., • Review clinical documentation across settings (center-based, home, inpatient, post-acute) to identify documentation gaps, risks, and opportunities., • Establish standards and workflows for compliant documentation clarification and provider query processes., • Perform targeted and high-risk chart reviews to validate diagnosis accuracy and chronic condition management., • Oversee the development and escalation of documentation queries in collaboration with coding staff., • Ensure documentation improvement efforts remain clinically, compliant, and audit-defensible., • Develop and deliver structured education for MD/DOs, Nurse Practitioners, and Physician Assistants focused on documentation accuracy, specificity, and annual condition recapture., • Provide real-time, retrospective, and trend-based feedback to providers in a collaborative, non-punitive manner., • Partner with Medical Directors and clinical leadership to reinforce accountability and documentation best practices., • Build, mentor, and lead a CDI and risk adjustment team (4–6 staff), including certified coders and clinical documentation professionals., • Establish role clarity, workflows, productivity expectations, and quality benchmarks for team members., • Provide clinical oversight and coaching to ensure alignment between documentation, coding, and risk adjustment goals., • Lead internal monitoring, auditing, and quality assurance activities related to documentation and risk adjustment., • Prepare for and support external audits including CMS RADV, payer, and state reviews., • Identify compliance risks, develop corrective action plans, and monitor resolution., • Ensure CDI and risk adjustment practices align with CMS regulations, organizational policies, and ethical standards., • Collaborate with coding, quality, compliance, finance, and operational leaders to align documentation integrity with organizational performance goals., • Engage with the Interdisciplinary Team to ensure documentation reflects the full clinical and functional complexity of participants., • Develop and present risk adjustment and documentation performance reports to leadership., • Support integration of risk adjustment principles into care planning, reassessment, and ongoing participant management., • Design scalable CDI and risk adjustment workflows to support organizational growth and maturity., • Evaluate EHR tools, templates, and reporting capabilities to improve efficiency and accuracy., • Maintain current knowledge of CMS guidance, ICD-10-CM updates, and evolving risk adjustment models., • Improvement in HCC capture and recapture rates, including chronic condition accuracy and annual recapture compliance., • Increased percentage of diagnoses meeting MEAT criteria., • Reduction in unsupported, vague, or non-specific diagnoses., • Positive performance trends in internal and external audits., • Improved provider documentation accuracy following education interventions., • Successful recruitment, onboarding, and retention of CDI and risk adjustment staff. Experience and Education • Active, unrestricted Registered Nurse (RN) license required., • Minimum of five (5) years of clinical nursing experience, with at least three (3) years in clinical documentation improvement, risk adjustment, or HCC-focused roles., • Demonstrated expertise Medicare Advantage, Medicaid, and/or PACE full-risk models., • Strong working knowledge of ICD-10-CM coding guidelines and CMS risk adjustment methodologies., • Experience educating and collaborating with provider-level staff (MD/DO, NP, PA)., • Prior experience leading or mentoring CDI or coding teams strongly preferred., • Professional certifications preferred (e.g., CCDS, CRC, CPC, CCS)., • Proficiency with EHR systems, data analysis, and clinical reporting tools. Pre-Employment Requirements • Must have reliable transportation, a valid driver's license, and the minimum state required liability insurance., • Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact., • Match begins after one year of employment
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