Clinical Documentation Improvement Manager
Nashville Public Radio, Iowa City, IA, United States
Position Overview
The Office of Clinical Documentation Improvement (CDI) at UI Health Care has an opening for a full‑time
CDI Manager . The CDI Manager provides leadership, direction, and oversight for clinical documentation improvement and education system‑wide, to ensure complete, accurate, compliant documentation that reflects patient acuity, supports quality outcomes, and enables appropriate reimbursement. The role leads, develops, and mentors the CDI Specialist team; designs and delivers clinical care provider and staff education (including residents and new providers); partners closely with Health Information Management/Coding, Quality, Analytics, Physician Advisors, and Clinical Departments; and drives process improvement and operational consistency across the enterprise.
Requirements
A Baccalaureate degree or master’s degree in nursing.
License to practice nursing in Iowa.
Minimum of two (2) years of recent work experience as a Clinical Documentation Improvement Specialist with at least three (3) years of clinical experience at an academic medical center.
At least one (1) year of managerial or supervisory experience, ELA acceptable.
Advanced clinical expertise and extensive knowledge of complex disease processes with a broad clinical experience in an inpatient setting required.
A broad knowledge of the disease process, normal/abnormal findings, and reasonable course of treatment, quality measures, and risk management issues is essential.
Healthcare education experience with a strong understanding of the requirements for clinical coding and billing according to the rules of Medicare, Medicaid, and commercial payers preferred.
Extensive knowledge of CDI related quality measures, including AHRQ measures and AHIMA query practice guidelines, knowledge of coding structures
ational coding guidelines and related appropriate chart documentation.
Demonstrated competency in teaching/learning process, organizational skills and computer literacy required, including proficiency with computer software applications utilized within the CDI programs (i.e. Excel, Word, PowerPoint, 3M 360).
Excellent professional demeanor and communication skills.
Excellent people skills with physicians, nursing staff, and interdisciplinary team members as demonstrated through written and verbal communication, including presentation and training skills.
Excellent organizational, time management and critical thinking skills.
Currently holds Clinical Documentation certification or obtains certification within one (1) year, i.e.,
Certified Clinical Documentation Specialist (CCDS),
Certified Documentation Improvement Practitioner (CDIP).
Electronic Medical Records experience (EPIC preferred).
Experience with performance improvement methodologies.
Experience with data mining and/or data analytics.
Key Responsibilities
Apply Process Improvement, Quality Engineering, and Management Engineering Concepts and Methodologies: Coordinate documentation improvement & coding audits, provide physician documentation improvement education at the department level, and make decisions regarding documentation for accurate ICD‑10‑CM/ICD‑10‑CM‑PCS code assignment.
Accountable for CDI nursing and department level successes indicated through indices such as SOI/ROM capture rates, CC/MCC capture rates, CMI analysis, physician query‑response rates, and financial variance tracking.
Work with program leadership to plan, develop, and implement clinical documentation education programs for providers, staff, the CDI Specialist team, and new CDI Specialists and patient care teams.
Institute strategies that facilitate effective collaboration among CDI and other departments.
Maintain and share expertise with MS‑DRG/APR‑DRG and IPPS, CMS guidelines and Official Coding Guidelines.
Work closely with Health Information Management, CDI Specialists, and the Quality Improvement Program to identify, review, and develop education on patient safety indicators, hospital‑acquired conditions, and other quality‑driven measures.
Assist in maintaining positive relationships with other departments and university colleges to facilitate collaboration and achievement of organizational goals.
Represent the CDI Director on hospital and UI Health Care subcommittees; chair committees as requested; represent UI Health Care on internal and external committees and associations as requested.
Work with CDI physician advisors to ensure clear understanding of their role and improve ongoing quality improvement for CDI.
Data Collection and Analysis
Review inpatient medical records prospectively to ensure accurate documentation and acuity representation.
Review surgical procedures for accurate ICD‑10/PCS coding.
Collaborate with analytics team, leadership, and coding department to assess documentation gaps and develop CDI educational tools.
Track, trend, and review data/metrics with team members and service line providers, focusing on strategies and education that facilitate documentation improvement and denials management.
Serve as a super‑user for vendor and software applications utilized by CDI, the Quality Improvement Program, and HIM.
Project Management
Manage projects providing support across the spectrum of documentation improvement, from identifying interdisciplinary champions to implementing process improvements, tracking metrics, and auditing results.
Work with leadership on projects to provide onsite support and education to CDI nursing staff, coders, physicians, case managers, and administration.
Manage multiple projects to promote accurate concurrent documentation across disciplines.
Ensure successful completion of projects that improve quality and completeness of clinical documentation and align with organizational mission.
Develop supporting documents to present to CDI Director and stakeholders.
Assist CDI Director with data and reports to evaluate program effectiveness and impact.
Lead CDI committees: meeting regularly for quarterly updates, onboarding new CDI nurses, and development of staff.
Quality Assurance and Compliance
Perform routine audits of documentation queries to identify knowledge gaps and improve accuracy.
Evaluate regulatory changes related to quality measures and educate staff.
Knowledgeable of legal issues involved in patient care information and exercise judgment regarding HIPAA and AHIMA query practices.
Collaborate with inpatient coding team to ensure adherence to processes and provide second‑level reviews when necessary.
Training and Education
Develop and implement consistent training for nursing staff, physicians, and mid‑level practitioners on documentation issues and quality metrics.
Teach and mentor other Clinical Department Specialists on CDI principles and serve as a resource to key stakeholders.
Lead CDI onboarding program to ensure efficient education of new CDI specialists.
Maintain a climate of learning that promotes educational experiences for all staff.
Assist with the implementation of system and process changes, including ongoing CDI staff training.
Leadership and Supervision
Provide daily oversight and supervision of CDI Specialists/RNs.
Promote departmental and organizational policy compliance with CDI Director.
Lead quarterly review meetings with individual CDI nurses and CDI Director.
Maintain reliable attendance and exceed performance expectations related to personnel and reporting responsibilities.
Act as delegate for Director when necessary.
Human Resources Administration
Hire, develop, and manage staff performance; ensure compliance with UI policies and procedures.
Develop and implement policies and practices supporting staff engagement.
Hold employees accountable for high performance and engagement by sharing data, articulating expectations, monitoring performance, and providing feedback.
Identify and provide opportunities for staff to develop necessary knowledge, skills, and abilities.
Assist with compliant record keeping related to staff education.
Provide backup mentoring for the CDI nursing team as needed.
Percent of Time
100% (full‑time)
Work Schedule
Some flexibility between the hours of 7:00 AM and 5:00 PM, Monday through Friday.
Location
Healthcare Support Services Building (HSSB), 3231 Ridgeway Drive, Coralville, IA 52241.
Pay Level
Pay Level 5B: Starting salary will be based on applicant’s qualifications and related/relevant experience. View the full pay range for pay level 5B: Professional and Scientific Pay Structures.
Benefits Highlights
Fringe benefit package including paid vacation, sick leave, health, dental, life, and disability insurance options; and generous employer contributions into retirement plans. Complete information regarding the full benefits package may be viewed at: https://hr.uiowa.edu/benefits.
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The Office of Clinical Documentation Improvement (CDI) at UI Health Care has an opening for a full‑time
CDI Manager . The CDI Manager provides leadership, direction, and oversight for clinical documentation improvement and education system‑wide, to ensure complete, accurate, compliant documentation that reflects patient acuity, supports quality outcomes, and enables appropriate reimbursement. The role leads, develops, and mentors the CDI Specialist team; designs and delivers clinical care provider and staff education (including residents and new providers); partners closely with Health Information Management/Coding, Quality, Analytics, Physician Advisors, and Clinical Departments; and drives process improvement and operational consistency across the enterprise.
Requirements
A Baccalaureate degree or master’s degree in nursing.
License to practice nursing in Iowa.
Minimum of two (2) years of recent work experience as a Clinical Documentation Improvement Specialist with at least three (3) years of clinical experience at an academic medical center.
At least one (1) year of managerial or supervisory experience, ELA acceptable.
Advanced clinical expertise and extensive knowledge of complex disease processes with a broad clinical experience in an inpatient setting required.
A broad knowledge of the disease process, normal/abnormal findings, and reasonable course of treatment, quality measures, and risk management issues is essential.
Healthcare education experience with a strong understanding of the requirements for clinical coding and billing according to the rules of Medicare, Medicaid, and commercial payers preferred.
Extensive knowledge of CDI related quality measures, including AHRQ measures and AHIMA query practice guidelines, knowledge of coding structures
ational coding guidelines and related appropriate chart documentation.
Demonstrated competency in teaching/learning process, organizational skills and computer literacy required, including proficiency with computer software applications utilized within the CDI programs (i.e. Excel, Word, PowerPoint, 3M 360).
Excellent professional demeanor and communication skills.
Excellent people skills with physicians, nursing staff, and interdisciplinary team members as demonstrated through written and verbal communication, including presentation and training skills.
Excellent organizational, time management and critical thinking skills.
Currently holds Clinical Documentation certification or obtains certification within one (1) year, i.e.,
Certified Clinical Documentation Specialist (CCDS),
Certified Documentation Improvement Practitioner (CDIP).
Electronic Medical Records experience (EPIC preferred).
Experience with performance improvement methodologies.
Experience with data mining and/or data analytics.
Key Responsibilities
Apply Process Improvement, Quality Engineering, and Management Engineering Concepts and Methodologies: Coordinate documentation improvement & coding audits, provide physician documentation improvement education at the department level, and make decisions regarding documentation for accurate ICD‑10‑CM/ICD‑10‑CM‑PCS code assignment.
Accountable for CDI nursing and department level successes indicated through indices such as SOI/ROM capture rates, CC/MCC capture rates, CMI analysis, physician query‑response rates, and financial variance tracking.
Work with program leadership to plan, develop, and implement clinical documentation education programs for providers, staff, the CDI Specialist team, and new CDI Specialists and patient care teams.
Institute strategies that facilitate effective collaboration among CDI and other departments.
Maintain and share expertise with MS‑DRG/APR‑DRG and IPPS, CMS guidelines and Official Coding Guidelines.
Work closely with Health Information Management, CDI Specialists, and the Quality Improvement Program to identify, review, and develop education on patient safety indicators, hospital‑acquired conditions, and other quality‑driven measures.
Assist in maintaining positive relationships with other departments and university colleges to facilitate collaboration and achievement of organizational goals.
Represent the CDI Director on hospital and UI Health Care subcommittees; chair committees as requested; represent UI Health Care on internal and external committees and associations as requested.
Work with CDI physician advisors to ensure clear understanding of their role and improve ongoing quality improvement for CDI.
Data Collection and Analysis
Review inpatient medical records prospectively to ensure accurate documentation and acuity representation.
Review surgical procedures for accurate ICD‑10/PCS coding.
Collaborate with analytics team, leadership, and coding department to assess documentation gaps and develop CDI educational tools.
Track, trend, and review data/metrics with team members and service line providers, focusing on strategies and education that facilitate documentation improvement and denials management.
Serve as a super‑user for vendor and software applications utilized by CDI, the Quality Improvement Program, and HIM.
Project Management
Manage projects providing support across the spectrum of documentation improvement, from identifying interdisciplinary champions to implementing process improvements, tracking metrics, and auditing results.
Work with leadership on projects to provide onsite support and education to CDI nursing staff, coders, physicians, case managers, and administration.
Manage multiple projects to promote accurate concurrent documentation across disciplines.
Ensure successful completion of projects that improve quality and completeness of clinical documentation and align with organizational mission.
Develop supporting documents to present to CDI Director and stakeholders.
Assist CDI Director with data and reports to evaluate program effectiveness and impact.
Lead CDI committees: meeting regularly for quarterly updates, onboarding new CDI nurses, and development of staff.
Quality Assurance and Compliance
Perform routine audits of documentation queries to identify knowledge gaps and improve accuracy.
Evaluate regulatory changes related to quality measures and educate staff.
Knowledgeable of legal issues involved in patient care information and exercise judgment regarding HIPAA and AHIMA query practices.
Collaborate with inpatient coding team to ensure adherence to processes and provide second‑level reviews when necessary.
Training and Education
Develop and implement consistent training for nursing staff, physicians, and mid‑level practitioners on documentation issues and quality metrics.
Teach and mentor other Clinical Department Specialists on CDI principles and serve as a resource to key stakeholders.
Lead CDI onboarding program to ensure efficient education of new CDI specialists.
Maintain a climate of learning that promotes educational experiences for all staff.
Assist with the implementation of system and process changes, including ongoing CDI staff training.
Leadership and Supervision
Provide daily oversight and supervision of CDI Specialists/RNs.
Promote departmental and organizational policy compliance with CDI Director.
Lead quarterly review meetings with individual CDI nurses and CDI Director.
Maintain reliable attendance and exceed performance expectations related to personnel and reporting responsibilities.
Act as delegate for Director when necessary.
Human Resources Administration
Hire, develop, and manage staff performance; ensure compliance with UI policies and procedures.
Develop and implement policies and practices supporting staff engagement.
Hold employees accountable for high performance and engagement by sharing data, articulating expectations, monitoring performance, and providing feedback.
Identify and provide opportunities for staff to develop necessary knowledge, skills, and abilities.
Assist with compliant record keeping related to staff education.
Provide backup mentoring for the CDI nursing team as needed.
Percent of Time
100% (full‑time)
Work Schedule
Some flexibility between the hours of 7:00 AM and 5:00 PM, Monday through Friday.
Location
Healthcare Support Services Building (HSSB), 3231 Ridgeway Drive, Coralville, IA 52241.
Pay Level
Pay Level 5B: Starting salary will be based on applicant’s qualifications and related/relevant experience. View the full pay range for pay level 5B: Professional and Scientific Pay Structures.
Benefits Highlights
Fringe benefit package including paid vacation, sick leave, health, dental, life, and disability insurance options; and generous employer contributions into retirement plans. Complete information regarding the full benefits package may be viewed at: https://hr.uiowa.edu/benefits.
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