Manager, Clinical Documentation Improvement

The mission of the University of Miami is to transform lives through education, research, innovation, and service. A vibrant and diverse academic and healthcare community, the University of Miami and the University of Miami Health System ("UHealth") have rapidly progressed to become one of the nation’s top research universities and academic medical centers in the nation.

Roles and Responsibilities 

The Manger of Clinical Documentation Integrity (CDI) provides daily leadership and oversight of the CDI Team. Under the direction of the CDI Director, works in association with other leaders, CDI Specialists, coders, quality specialists, data analysts, providers, and other members of the healthcare team to ensure accurate clinical documentation in the medical record. The CDI Manager maintains oversight of all phases of the CDI process to ensure compliance, accuracy, care quality, and severity are reflected. Oversees the daily workflow of the CDI staff while applying CDI expertise.

• Supervises all phases of the clinical documentation process and applies CDI review expertise to ensure compliance, accuracy, specificity, and severity captures are obtained consistently by all reviewers. Support staff as the key resource for clinical documentation and coding.
• Maintain concurrent and retrospective review expertise to ensure accuracy, specificity, and severity captures are obtained consistently by all reviewers.
• Develops policies, systems, and processes for CDI, updating as needed.
• Identifies areas of improvement within CDI and other related functional areas and initiates solutions.​
• Serves an escalation point for CDI-Coder DRG discrepancies and query requests.
• Promotes effectiveness of the CDI program through leadership and management skills.
• Ensures accuracy and completeness of information used for measuring and reporting CDI, physician, and hospital outcomes.
• Generates and analyzes data reports for monitoring performance and identification of opportunities for improvement; makes recommendations based upon data analysis.
• Ensure that key performance metrics are met and provide proactive intervention as needed. This is accomplished through data analysis, direct observation, expert review of medical records, and daily staff interactions.
• Works with vendors and/or internal stakeholders as CDI subject matter expert to analyze issues and develop solutions.
• Provides education to the medical staff and the healthcare team regarding clinical documentation opportunities, coding and reimbursement issues, as well as performance improvement methodologies.
• Manages personnel, ensuring effective team building and conflict resolution.
• Conducts/oversees CDI review quality and query compliance audits. Implements educational strategies to ensure compliance with quality standards.
• Regulates staffing in accordance with fluctuating workload and shifting departmental priorities.
• Conducts HR management activities including, but not limited to, interview, hiring, orientation and training, performance evaluations, performance enhancement plans and/or disciplinary actions.
• Perform duties and conduct interpersonal relationships in a manner that promotes a team approach and collaborative work environment with physicians, CDI staff, coders, and leaders.
• Assumes responsibility for professional development through participation at workshops, conferences, and/or in-services and maintains appropriate records of participation.
•  Understands and disseminates reports to appropriate administrative personnel indicating performance metrics and impact of the CDI program.
• Collaborate with CDI Specialists, Educators, Auditors, Director, and Physician Champions/Advisor regarding any physician engagement concerns and action plan recommendations.
• Performs expert CDI chart reviews and complex second-level reviews (concurrent and retrospective) as needed.
• Assists with special projects and other duties as deemed necessary by CDI Director, and/or other department leadership.
• Seeks guidance from the Director and/or upper management for unusual or unanticipated circumstances that require deviation from policy/practice or allocation of funds to resolve.
• Actively participates in meetings, departmental and hospital committees, and assigned task force groups.
• Communicates effectively, timely and in open and honest manner, sharing knowledge and skills with colleagues and others.
• Displays mental and emotional effort required to function effectively in an environment with multiple and fluctuating priorities. Demonstrates professionalism, tact and diplomacy required for communication with providers, ancillary and nursing departments, department and administrative leaders.
• Serves as a resource to Physicians and other key healthcare staff in matters relating to DRG information and/or clinical documentation principles.

This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

Minimum Qualifications

Education

• Bachelor’s degree in nursing required (BSN/BS/BA).
• Graduate Degree Preferred in Healthcare Administration, Informatics, Nursing, Leadership, Education or related field.
• FMG (MD) with extensive clinical and CDI experience will also be considered.

Certification and Licensing

• Current and Active Registered Nurse license.
• CDI certification required: Certified Documentation Specialist (CCDS) by ACDIS or Certified Clinical Documentation Improvement Practitioner (CDIP) by AHIMA.
• Coding certification preferred: Certified Professional Coder (CPC) by AAPC or Certified Coding Specialist (CCS) by AHIMA.

Experience

• At least four (4) years acute care clinical documentation improvement specialist experience required.
• Thorough knowledge of ICD-10-CM/PCS, APR DRG and MS DRG, Mortality, AHRQ PSI, CMS HAC, Vizient, U.S. News & World Report, and CDI best practices required.
• Excellent written and verbal communication skills; ability to write concisely and effectively when communicating with providers.
• Knowledge of age-specific patient needs and the elements of disease processes and related procedures.