Clinical Documentation Integrity Manager (CDI Manager)

POSITION SUMMARY:

The Outpatient Clinical Documentation Integrity (CDI) Manager is a key figure in supporting patient care at RIPCPC. The CDI Manager is responsible for managing clinical documentation functions, overseeing the administrative responsibilities for staff, and daily assignment of cases for the clinical documentation staff. Provides the necessary leadership to achieve the objectives of Rhode Island Primary Care. Must plan, develop, and manage efficient and effective processes for CDI activities. Services provided must meet the medical, administrative, legal, ethical, regulatory and institutional requirements utilized in the health care delivery system. Will serve as the first-level resource for the Clinical Documentation Integrity team in addition to performing the functions of a Clinical Documentation Integrity Specialist (CDIS) as needed. This Outpatient CDI Manager role is not just a job but a dedication to the patients attributed to RIPCPC.

ESSENTIAL FUNCTIONS: To perform this job, an individual must perform each essential function satisfactorily with or without reasonable accommodation.

Strategy:

• Develop and implement CDI strategies based on need of the CDI program and organizational goals
• Work closely with project managers, coders, clinicals teams, and leadership to align documentation with clinical and financial objectives
• Identify gaps in daily operational workflows and provide recommendations for process redesign
• Use expertise to drive coding accuracy for complexity and medical necessity, improving the quality of care and patient outcomes for outpatient services and associated risk adjustment.

Management and Education:

• Coach, train and mentor CDI specialists and clinical staff to improve documentation practices
• Develop and deliver educational materials for providers and team members, including but not limited to coding guidelines, risk adjustment, compliance, and regulatory changes
• Serve as subject matter expert on advising internal and external stakeholders on best practices in clinical documentation
• Facilitate collaboration between CDI team and external stakeholders to optimize program outcomes
• Deliver educational presentations to physicians (on-boarding, one-on-one, or routinely), group practices, and administration.

Monitoring and Reporting:

• Monitor and evaluate the effectiveness of CDI program, providing recommendations for enhancements
• Ensure documentation meets current ICD-10-CM coding guidelines
• Audit CDI staff for adherence to regulatory compliance guidelines, identify gaps in risk adjustment coding opportunities, leverage audit results to develop education content, and provide feedback
• Assists with generating key reports and ROI for internal and external review
• Analyze and interpret key performance indicators and reports generated for review

Additional Information:

Access to and works with sensitive and confidential information.

Exhibit a comprehensive understanding of healthcare regulatory and compliance (e.g., HIPAA) information. Skilled in the application of policies and procedures. Knowledge of business office standards and recommended practices.

This position is 100% remote.

Qualifications:

· Bachelor’s Degree required

· 3 years minimum of CDI experience, including two (2) years of leadership experience in OP CDI Risk Adjustment, including training and provider education

· 3 years of OP/CDI HCC Risk Adjustment experience, including partnering with physician leadership groups

· Licensed as a Registered Nurse (RN)

· Experience with value-based care contracts

· Certified Risk Adjustment Coder (CRC) required; will consider Certified Clinical Documentation Specialist – Outpatient (CDSS-O) as needed

· The requirements below represent the required knowledge, skills, and abilities

Skills and Abilities:

This position requires an understanding and knowledge of physician documentation requirements in a clinic setting to capture patients’ acute and chronic conditions

• Strong communication skills
• ICD-10-CM Coding experience
• Knowledge of value-based care contracts
• Knowledge of HCCs and other risk models, such as CDPS and John Hopkins ACG.
• Proficient critical thinking, reasoning, and deduction to draw accurate clinical conclusions
• Ability to navigate various electronic health records and utilize AI/NLP technologies
• Positive attitude and team player
• Ability to collaborate with and educate providers
• Ability to develop and present compelling presentations

Physical and Mental Demands:

The physical demands described here represent those that an employee must meet to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform essential job responsibilities.

While performing the duties of this job, the employee is occasionally required to stand; walk; sit for extended periods; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, bend, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 20 pounds. The repetitive motion of the upper body required for extended use of a computer. Required specific vision abilities include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Rhode Island Primary Care Physicians Corporation Overview:

Rhode Island Primary Care Physicians Corporation (RIPCPC) is a multi-specialty Independent Practice Association (IPA) of physicians located throughout the State of Rhode Island. RIPCPC, originally formed in 1994, currently represents over 150 primary care physicians (PCPs) from family practice, internal medicine, and pediatric medicine. The IPA also represents over 200 specialty-care member physicians which include behavioral health, optometry and ophthalmology, gastroenterology, and cardiology. RIPCPC delivers support services that are essential to providing high quality, cost-effective medicine to their patients, while also preserving community-based practices. Our PCPs provide care to over 130,000 Rhode Islanders.

Rhode Island Primary Care Physicians Corporation is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Job Type: Full-time

Pay: $110,000.00 - $115,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Professional development assistance
• Retirement plan
• Vision insurance

Schedule:

• Monday to Friday

Work Location: Hybrid remote in Cranston, RI 02920

Salary : $110,000 - $115,000