5+ years as a registered nurse with 2+ years in healthcare management/leadership in an inpatient setting.
Current California RN License or equivalent clinical degree required.
Preferred certifications: CCDS, CDIP, CCS, RHIA, or RHIT.
BSN or bachelor's degree in a healthcare-related field required; master's preferred.
Strong understanding of ICD coding and clinical documentation standards.
Responsibilities
Oversee daily operations of the Clinical Documentation Improvement (CDI) Program.
Educate patient care teams on documentation guidelines and standards.
Conduct concurrent reviews of physician and ancillary documentation.
Monitor performance and analyze data for process improvement.
Produce measurement reports on CDI processes and progress.
Ensure compliance with regulatory requirements related to CDI.
Collaborate with medical and compliance leadership to enhance the CDI Program.
Benefits
Comprehensive health insurance options.
Retirement savings plan with employer matching.
Professional development opportunities.
Flexible work environment.
Supportive team culture focused on collaboration.
Full Job Description
Job Brief
1 Opening
Pay Range: SUPERVISOR, CDI - $112,257.60 to $179,608.00
Job Summary
Under the direction of the Director of Health Information Management, the Supervisor of Clinical Documentation Improvement (CDI) has the overall responsibility of carrying out the defined processes of the day-to-day operations and activities of the CDI Program. These operations/activities include: providing education and support to the patient care team regarding documentation guidelines, including physicians, nursing, and other interdisciplinary team members, to produce an accurate and specific accounting of the medical care provided to our patients. Overseeing and performing the processes and personnel responsible for concurrent review of physician and ancillary documentation to identify severity of illness, risk or mortality, and specificity and etiology of diagnoses, while demonstrating adherence to appropriate documentation standards. Leads the monitoring of performance, collection and analysis of data to report on the effectiveness of process improvement. Produce measurement reports of CDI processes and progress, and demonstrate excellent communication skills with physicians. Collects and analyzes data to provide reports for hospital wide use and to make recommendations as appropriate. Ensures compliance of regulatory requirements as related to CDI. Participates in the planning, development and implementation, and ongoing success of the Clinical Documentation Improvement Program. Works collaboratively with the Chief Medical Officer, facility Compliance Officer and clinical department managers to achieve and maintain a successful Clinical Documentation Program.
What You'll Bring to the Team:
Strong verbal and written communication skills.
Outstanding analytical skills and strong clinical thinking skills required
Ability to work with minimal supervision required
Effective two way communication skills (listening and speaking); strong interpersonal skills with medical staff, coders and other personnel as needed.
Licensure and Certification:
Current California RN License or other clinical medical degree
Certification as CCDS, CDIP or CCS, RHIA or RHIT is preferred.
Education:
BSN or bachelor's degree in a healthcare-related field required
Master's degree in a healthcare-related field preferred
Experience:
At least 5 years' experience as a registered nurse, a minimum of 2 years of recent healthcare management/leadership in an inpatient setting
Case management or Quality experience preferred
Understanding of ICD coding strongly preferred
Understanding of clinical documentation standards strongly preferred
2 years' experience as lead or supervisor or equivalent, such as program coordination.
