Under general direction from the CDI Supervisor and Manager, the CDI Specialist RN Ld provides advanced clinical documentation integrity (CDI) expertise and serves as a functional lead for inpatient CDI practice at Valleywise Health. This role supports CDI staff education, mentorship, and competency development to ensure consistent application of clinical validation standards, regulatory requirements, and compliant documentation practices. A key responsibility includes advanced review of DRG downgrades and audit activity (including RAC reviews), providing clinical insight to support appeal determination and development. Findings and trends are translated into targeted education, quality improvement initiatives, and workflow enhancements. The CDI RN Lead partners closely with CDI leadership, Physician Advisors, coding, quality, compliance, and revenue cycle stakeholders to strengthen documentation accuracy, reduce reimbursement risk, and support high-quality, compliant patient care documentation.
Annual Salary Range: $83,116.80 - $132,995.20QualificationsEducation:- Requires a bachelor's degree in nursing, or an advanced clinical degree (MD, DO, PA, NP).
Experience:- Must have a minimum of seven (7) years of clinical documentation-related experience that demonstrates a solid understanding of the required knowledge, skills, and abilities.
- Must have demonstrated experience with DRG downgrade review, payer denials, and audit support.
- Must have experience providing staff and peer education.
- Must have experience leading and/or performing mortality reviews.
Certification/Licensure:- Requires a current, valid AZ RN license, or valid compact RN licensure for the current state of practice, or an advanced clinical degree (MD, DO, PA, NP).
- Requires a Certified Clinical Documentation Specialist (CCDS) or Clinical Documentation Improvement Professional (CDIP).
Knowledge, Skills, and Abilities:- Advanced knowledge of ICD-10-CM/PCS, MS-DRG/APR-DRG methodologies, risk adjustment, and coding compliance.
- Strong clinical validation expertise and critical-thinking skills.
- Ability to deliver effective education to CDI staff and medical providers.
- Strong written and verbal communication skills.
- Proficiency with Epic and CDI/coding tools (e.g., 3M or similar systems).
- Demonstrated ability to analyze data, identify trends, and recommend improvements.
- Proficient computer skills (Word, Excel, PowerPoint).
