Regional Manager, Clinical Documentation Integrity (Remote)

Clinical Documentation Integrity Manager

Work Remote Position

Responsible for directing Clinical Documentation Integrity (CDI) activities for the Health Ministries (HM) in their defined region and day-to-day management of the CDI programs. Works with Director, CDI to ensure the program is in alignment with the Trinity Health CDI Program standards, policies, procedures, workflows. Uses available tools and reports to monitor CDS productivity, accuracy and compliance and will be responsible for addressing and refining processes to improve performance and achieve defined goals. Provides training and education to clinical documentation specialists (CDS) to enhance clinical and coding skill sets and optimal utilization of 3M CDI software.

Analyzes data to determine educational opportunities and will create and provide training to documenting providers to improve documentation quality.

Works closely with Regional and Local Health Physician Champions, Chief Medical Officers, HM Executive Leadership, clinical staff, coding and denials teams to facilitate documentation within the medical record and supports the patient's severity of illness, risk of mortality, clinical validity and proper DRG assignment.

Essential Functions

Knows, understands, incorporates and demonstrates the Trinity Health Mission, Vision and Values in leadership behaviors, practices and decisions.

Ensures HM CDI Team compliance with Trinity Health CDI Program standards, policies, procedures, workflows, and CDI software standard use and adoption.

Monitors system CDI Dashboard and HM CDI Monitoring Reports to identify opportunities for improvement and areas of focus for the HM CDI programs.

Develops and implements action plans for program performance under target benchmarks.

Understands and communicates appropriate clinical documentation and clinical validation to ensure that the severity of illness, risk of mortality and level of services provided are accurately reflected in the health record. Assists in overall quality, timeliness and completeness of the quality health record to ensure appropriate data, provider communication and quality outcomes. Serves as a resource for appropriate clinical documentation.

Develops CDS team through hiring, maintaining work schedules, balancing workload and conducting performance evaluations. Mentors and coaches colleagues to ensure positive outcomes.

Demonstrates a thorough understanding of the MS-DRG system, CCs / MCCs, impact on quality and CMI as well as ICD-10 coding systems and the guidelines related to Clinical Documentation Improvement. Serves as a resource for the CDS team for any of the above.

Ensures that direct reports remain current in coding guidelines and other regulatory directives that impact CDI performance. Ensures all compliance and regulatory standards are met.

Ensures that direct reports perform clinical validation as part of the review process and remain current on CDI strategies.

Uses 3M / 360 for entering and abstracting data related to CDI performance. Monitors the CDI Dashboard and reporting to identify opportunities for improvement and areas of focus.

Communicates with and educates physicians and all other members of the healthcare team regarding clinical documentation, and monitors provider participation. Identifies learning opportunities for healthcare providers.

Ensures that direct reports communicate, educate and engage with physicians and other members of the healthcare team regarding clinical documentation.

Collaborates with coding leaders to assure documentation of diagnoses and co-morbidities are a complete reflection of the patient's clinical status and care. Resolves all discrepancies in a courteous manner.

Demonstrates expertise in problem-solving skills based on theoretical knowledge, clinical experience and sound judgment and serves as a professional role model by demonstrating desirable practice behaviors.

Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health Corporate Integrity Program, Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

(Pay Rate : $50.7955-$83.8126)

Minimum Qualifications

Bachelor's degree in Health Information Management, Healthcare related field or Nursing or the equivalent in experience.

Must possess one of the below :

• Current Registered Nurse (RN) License
• Registered Health Information Administrator (RHIA)
• Registered Health Information Technician (RHIT)
• Certified Coding Specialists (CCS)
• Licensure as a physician assistant (PA) or Nurse Practitioner / Advanced Practice Nurse (NP / APN) or completion of medical school
• Certified Clinical Documentation Specialists (CCDS) or Certified Documentation Improvement Professional (CDIP) preferred

Minimum of five (5) years of progressively responsible operational or management experience with prior work experience in a hospital clinical documentation integrity program.

Previous experience at the corporate or enterprise level desirable.

Must have thorough knowledge of CMS regulations, coding guidelines and DRG reimbursement.

Project management and / or system implementation experience required.

Must possess strong analytical skills in order to understand how the data impacts revenue cycle and quality metrics.

Ability to influence and engage direct and indirect reports as well as peers to achieve results.

Excellent interpersonal skills with ability to build collaborative working relationships with clinical staff, finance and compliance.

Excellent written and oral communication skills; ability to write clearly and succinctly in a variety of communication settings and styles.

Ability to address complex problems with multi-level impacts using sound judgment, in-depth analysis and expertise to resolve issues.

Strong knowledge of IT applications and technology and their impacts on productivity and workflow.

Intermediate computer skills required, including working knowledge of an experience using MS Word, Excel, Outlook, Teams and PowerPoint. Must be able to spend majority of work time utilizing a computer, monitor and keyboard.

Ability to create and implement business strategies and processes to address changing healthcare environment and reimbursement.

Maintains professional attitude and ability to relate well with executive management, physicians, other care providers, colleagues, and patients.

Strong understanding of the Catholic health ministry in an evolving health care delivery system and changing reimbursement market.

Must be able to operate effectively in a collaborative, shared leadership environment.

Personal presence that is characterized by a sense of honesty, integrity, and caring as well as the ability to inspire and to motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

Physical and Mental Requirements and Working Conditions

Ability to work in a fast-paced, multi-customer environment, with conflicting needs. May warrant varied and / or extended hours, with changes in workload and priorities to keep pace with the industry and advanced strategic priorities.

Must possess the ability to comply with enterprise policies and procedures.

Must be able to spend majority of work time utilizing a computer, monitor and keyboard.

Must possess a valid driver's license and be able to travel to the various Trinity Health locations as well as the System Office.

The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.