Nurse Administrator (Lead Clinical Documentation Improvement Specialist)

Lead Clinical Documentation Specialist

The University of Illinois Hospital & Health Sciences System (UI Health) provides comprehensive care, education, and research to the people of Illinois and beyond. A part of the University of Illinois Chicago (UIC), UI Health comprises a clinical enterprise that includes a Joint Commission-accredited tertiary care hospital and outpatient clinics, and the Mile Square Health Center network of federally qualified health centers. It also includes the seven UIC health science colleges : the College of Applied Health Sciences; the College of Dentistry; the School of Public Health; the Jane Addams College of Social Work; and the Colleges of Medicine, Pharmacy, and Nursing, including regional campuses in Peoria, Quad Cities, Rockford, Springfield, and Urbana. UI Health is dedicated to the pursuit of health equity.

This position is intended to be eligible for benefits. This includes Health, Dental, Vision, Life Insurance, a Retirement Plan, Paid time Off, and Tuition waivers for employees and dependents.

Position Summary

The Lead Clinical Documentation Specialist assists with the day-to-day oversight and reviews the progress of the Clinical Documentation Improvement program through interpretation of the CDI and quality rating reports under the leadership of the Clinical Documentation Improvement Director. The Lead CDI role leads, provides, and maintains clinical documentation improvement (CDI) practices to ensure consistency and meet coding rules, query compliance, and organization compliance guidelines. Works closely with the CDI Director, CDISs, Quality department, and the HIM department in the management of patient encounters that may include DRG optimization, assists with clinical denials, ensures that the quality measures (HACs and PSIs) are accurately captured, and assists with mortality reviews.

Duties & Responsibilities

Principal Responsibilities

• Assists the Clinical Documentation Improvement Director with the daily oversight of the CDI team
• Assists the CDI Director with tracking the CDI productivity metrics, performs quality reviews, captures areas for improvement, identifies educational needs, and prioritizes workload effectively
• Performs case reviews, initiates queries, and conducts the reconciliation process as per CDI workflows
• Strategizes approach and process refinements to capture opportunity within the CDI team (prioritization, assignment, etc.) based on retrospective and second-level reviews
• Works collaboratively with Health Information Management (HIM), Coding, Quality, Case Management, and Compliance to ensure accurate documentation for appropriate reimbursement and quality reporting.
• Assists the CDI Director in clinical denials management and identifies opportunities to reduce future denials
• Serves as a subject matter expert in clinical data reporting and leads the overall quality and completeness of the clinical documentation improvement through the application of evidence-based knowledge, in-depth review, interpretation, analysis, and identification of opportunities, communication, and consistent follow-up and evaluation of medical record documentation.
• Monitors internal CDI key indicator metrics related to revenue cycle, provider performance, and quality outcomes
• Identifies opportunities for provider education to improve the medical record documentation for the overall accuracy of the medical record
• Responsible for onboarding and ongoing competency development for the CDI team, and participates in CDI-related projects
• In conjunction with the CDI Director, contributes to the development and training opportunities for the CDI staff and other duties as assigned
• Collaborates directly with providers to clarify documentation to accurately and completely reflect the patient's medical conditions
• Other duties as assigned
• Perform other related duties and participate in special projects as assigned.

Minimum Qualifications

Other Knowledge Base Skills

1. Knowledge of ICD-10-CM / PCS Guidelines in Coding and Reporting, CMS guidelines, and Quality measures 2. General knowledge and proficiency in CDI / encoder Software (3M / Solventum / Optum) and Epic EMR 3. Ability to analyze data and prepare PowerPoint presentations 4. Ability to prepare and analyze data to drive performance and priorities for improvement

Preferred Qualifications

1. Master's degree in nursing (MSN) or another healthcare-related field 2. At least 2 years of supervisory / administrative experience in a health care field. 3. At least 2 yrs. of CDI educator, or CDI auditing experience.