Remote Manager, Clinical Documentation Integrity Services (RN)

Job Overview

  • Clinical License RN
  • State(s) Nationwide

Job details

Job Type
Full-time

Full Job Description

Overview:

Responsibilities:

DHG Healthcare is ranked by Modern Healthcare as the 10th largest privately-held healthcare consulting firm and serves the industry with approximately 300 dedicated healthcare industry professionals across consulting, assurance and tax. DHG Healthcare’s consulting business includes a distinctive capabilities and solutions portfolio sharply focused on critical business issues facing healthcare organizations in today’s transformative environment.
  • Serves as a Subject Matter Professional and resource in Clinical Documentation Improvement for DHG Healthcare
  • Assist in developing/expanding DHG Healthcare Clinical Documentation Services consulting offerings, including complementary engagements within Strategy and Enterprise Intelligence capability stacks
  • Evaluate existing client operations and identify gaps and/or improvement opportunities
  • Perform chart reviews to assess appropriate MS-DRG, 3MTM APR-DRG Severity of Illness (SOI) and Risk of Mortality (ROM) assignment, Hierarchical Condition Category capture (Inpatient and Outpatient)
  • Participate in engagements which may be related to due diligence or regulatory compliance with a defined scope related to clinical documentation and or coding as an emphasis
  • Perform CDI operational assessments utilizing DHG Healthcare’s Process Acclimation Review methodology, which will require application of core clinical, quality and coding knowledge to perform analysis of client workflows and processes to determine appropriate recommendations to improve clinical documentation, risk adjustment, care coordination and/or quality outcomes measurements
  • Deliver DHG’s proprietary and multi-modal (didactic, canvassing and small group) curriculums for Clinical Documentation Precision, Risk-Adjustment, and Physician Focused Training
  • Collaborate with interdisciplinary teams including, but not limited to, physicians, nurse practitioners, PA’s, and the department managers for, Clinical Documentation Improvement, Health Information Management Care Coordination, Quality, Revenue Cycle, Performance Improvement, Compliance, etc. as necessary
  • Distill findings from operational assessments and chart reviews into client facing reports that are clear, concise and contain actionable information
  • Utilize DHG tools (DHG ChaRT and Outpatient Review Tool) and on occasion client-specific software for monitoring of client progress in attaining both legacy and contemporary benchmark metrics for proficiency in CDI, Coding, Risk-Adjustment and Quality
  • Manage a variety of concurrent clinical documentation and other projects and consulting teams
  • Demonstrate thought leadership, manage complex projects, build client relationships, mentor consulting staff and collaborate with others to develop new business
  • Monitor and respond to project budget performance metrics, including assisting in determining project workplans, resource allocation models, timelines and resource requirements for development of project artifacts, deliverables and reports
  • Assume responsibility for professional development through participation in internal (CPE) and external CEU activities, workshops, conferences and/or in-services and maintains appropriate records of participation
  • Demonstrate successful completion of ongoing proficiency and compliance with regulatory requirements
  • Maintain updated clinical knowledge and stay abreast of guidelines and regulations affecting Clinical Documentation, Alternative Payment Models, Risk Adjustment, Coding and Quality Fields
  • Maintains fluency in software commonly used in the clinical documentation and coding realm including encoders, groupers, Computer Assisted Coding and CDI solutions and EMR’s through a combination of client facing activities and industry knowledge gained through participation in trade shows, and via interactions with software vendors in the CDI/Coding and Quality Improvement spaces
#LI-BS
#LI-REMOTE

Qualifications:

This is a hands-on role that both leads consulting engagements and project manages them, but also does delivery both onsite and remote. Must have proficiency to do both concurrent and retrospective chart reviews, including functioning as a CDI Specialist and a Coding/CDI Reviewer. Must have confidence in coding domain in addition to CDI and feel confident in work with physicians, CDI specialists, Coders, HIM and CDI Leaders, CFO’s and VP’s of Revenue Integrity.

Experience and Skills:
  • Bachelor’s degree from accredited college or university in a health-related field AND licensure as a Registered Nurse required
  • At least one of the following credentials or professional licenses is required: CCS, RHIA or RHIT
  • RN candidates with CCDS or CDIP will be considered. However, upon hire, will be required to obtain a CCS within 1 year of being hired
  • 5+ years clinical practice experience in the acute care hospital setting required; additional experience in ambulatory care settings is preferred
  • 3+ years in a supervisory capacity in a hospital environment such as clinical department, clinical documentation improvement, utilization management, care management, quality management or health information management required
  • 3+ years’ experience in a consulting role related to CDI and Coding required
  • Demonstrated ability to discern and interpret complex data sets to diagnose root cause or performance variances and design remediation strategies based on data and observations required
  • Demonstrated skill in preparing client-facing artifacts and writing reports which are clear, concise and actionable required
  • Working knowledge of federal, state and payer specific regulations and policy’s pertaining to clinical documentation, coding and quality improvement programs including pay-for-performance programs required
  • Working knowledge of official coding guidelines, CMS and JCAHO clinical documentation and quality improvement requirements, accepted evidence-based treatment guidelines, and data collection techniques required
  • Working knowledge of CMS Mandatory and Voluntary alternative payment models (Medicare Advantage, Value Based Purchasing, Readmissions Reduction Program, Mortality Reductions Programs, Comprehensive Joint Care BPCI-A, MIPS and MACRA) and applicability to the Clinical Documentation, Coding and Quality Improvement domains required
  • Strong grasp of risk adjustment concepts and impacts to Alternative Payment Models and Quality Programs required
  • Demonstrated ability to work collaboratively in cross functional teams both within DHG Healthcare and in client sites required
  • Experienced in making presentations to diverse groups such as C-Suite executives, physicians and hospital department leaders required
  • Able to interpret, adapt, and apply guidelines, procedures, and continuous quality improvement initiatives required
  • Able to analyze complex clinical scenarios and apply critical thinking preferred
  • Comfortable with ambiguity and skillful at applying strategies to work in projects where ambiguity is present requried
  • Must be self-directed, able to organize and manage multiple concurrent projects, balancing client needs with other demands on time preferred
  • Computer knowledge of MS Office, Excel, Adobe, Tableau, MS Word, and MS PowerPoint preferred
  • Software fluency with common CDI, Coding, Quality and EMR solutions required

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