Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.

We are always looking for people inspired to help us in our mission. If you are someone who wants to change the lives of patients, drive success for our partners and be part of a team driven to improve care, we may have your next opportunity.

 POSITION SUMMARY:
The Manager of Clinical Documentation Integrity directs the activities of the Clinical Documentation Integrity (CDI) program for their assigned facilities. The CDI Manager is responsible for providing CDI program oversight and day-to-day implementation and management of processes related to the concurrent review of the clinical documentation in the inpatient medical record. This includes, but is not limited to, overall responsibility for the planning, administration, control, and quality management of CDI Department activities in addition to regular reporting of department progress and initiatives to hospital leadership.  This position also provides oversight to the DRG Downgrade Appeals Specialist team.

This position collaborates with providers and other healthcare team members to make improvements that result in accurate, comprehensive documentation that reflects completely the clinical treatment, decisions, and diagnoses for the patient. This position utilizes clinical expertise and clinical documentation integrity practices and facility specific tools for best practice and compliance with the mission/philosophy, standards, goals, and core values of Lifepoint. 

The CDI Manager is involved in the education of all phases of the Clinical Documentation Improvement process across a service area. Provides ongoing Clinical Documentation Integrity education for physicians & new staff and new initiatives or identified areas of knowledge deficit. Tracks and trends program compliance to determine areas of focus for educational opportunities. 

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

• Oversee the operations and human resource needs of the CDI and DRG Downgrade team for assigned facilities.
• Direct and maintain adequate staffing and workflow to meet CDI and DRG Downgrade team’s needs.
• Monitor various reports and productivity to ensure that production standards and objectives are met in areas of responsibility.
• Lead the CDI program as demonstrated by assuming accountability for the ongoing success of the Clinical Documentation Integrity and DRG Downgrade Programs. 
• Monitor CDI program and communicate with appropriate facility leadership regarding CDI key performance indicators (KPIs) and identifies and implement process changes to maintain and improve KPIs.
• Develop and execute appeals management strategies for the DRG downgrade team.
• Develop and monitor key DRG Downgrade KPIs.
• Assure appropriate action is taken within appeal time frames to address DRG downgrade denial.
• Serve as subject matter expert on denial rationales and identify primary downgrade issue.
• Provide feedback and coaching to staff on well written appeal arguments based on clinical evidence within the medical record and evidence-based literature.
• Ensure appeals follow current industry clinical guidelines, evidence based medical, community and national medical management standards and protocols.
• Systematically analyze problems, draw relevant conclusions and devise appropriate courses of actions based on denial and overturn data.
• Provide clinical support for producing high quality, timely, and effectively written appeals.
• Engage and consult with Physician Advisor and/or CMO to resolve provider issues regarding answering clarifications and participation in the clinical documentation improvement process.
• Serve as a resource to Physicians / Case Managers and other key professional staff in matters relating to clinical documentation improvement & ICD-10.
• Work with medical records, quality, finance, and physician groups to develop systems to facilitate complete documentation for data reporting purposes.
• Develop and monitor strategic operating goals, objectives, and budget; and reports operational performance, justification and/or corrective action.
• Develop and manage direct reports; and oversees the development and management of indirect reports.
• Build and maintain productive inter/intra departmental and vendor work relationships to optimize operations.
• Ensure Clinical Documentation Integrity education for providers & new staff and new initiatives or identified areas of knowledge deficit. Track and trend program compliance to determine areas of focus for educational opportunities.
• Design and implement education programs which provide education for CDI staff
• Develop and ensures ongoing CDI education for new staff is delivered
• Report program progress/operations to hospital leadership on a monthly basis.
• Maintain regular and reliable attendance.
• Perform other duties as assigned.

Education:  Nurse (RN, NP, or graduate of a state approved nursing program), or Physician (MD, DO, FMG), or Physician Assistant (PA) 

Experience: 

• Minimum of 5 years of CDI experience in an acute inpatient setting
• Minimum of 2 years of direct management experience
• Prior Leadership of people and projects
• Strong Analytical skills (with CDI metric related focus)
• 3+ years of Excel experience
• Experience with CAC technology preferred

Certifications: CCDS or CDIP certification; CCS Certification preferred