Clinical Documentation Improvement
5 months ago
Summary
The Clinical Documentation Improvement (CDI)/Utilization Review Manager will manage the day-to-day functions of both Programs to ensure their success across the organization. As the CDI Manager, they will ensure that the CDI Nurses are performing their clinical documentation validations timely and efficiently and in accordance with regulatory compliance requirements for Coding and Documentation using Coding guidelines such as AHA Coding Clinic and AHA Coding guidelines. As the Utilization Review Manager will ensure that patients are meeting clinical criteria based on review of the documentation and following insurance payer rules/regulations based on either established Length of stay metrics or the MS DRG based ALOS/GMLOS metrics established by CMS. The CDI/UR Manager will work closely with CDI Supervisor and UR Supervisor to ensure that both programs are efficient ongoing and provide support to both groups ongoing as well. The CDI/UR Manager is an expert in both or one of the areas of assignment and has a complete understanding of the measures of success needed to run both programs to ensure CoxHealth viability/serving the needs of the community it serves. The CDI/UR Manager will work closely with the Medical Director-Coding/IP Coding and Medical Director-Utilization Review to ensure programs are running efficiently and their expertise will be vital in provider education to meet our Goals. Job Requirements Education Required: Associates Degree in Nursing (ASN). Preferred: Bachelor's Degree in Nursing (BSN). Experience Required: 3 years' experience in Clinical Documentation Improvement or Utilization Review. Required: 3 years’ minimum of management experience either as a Supervisor within CDI or Utilization Review. Skills Represents the department on several process improvement, standardization and regulatory committees. Operates strategic plan by setting and monitoring Key Performance Indicators related to CDI/UR. Ability to work with multiple people with meeting numerous requests and deadlines. Detailed knowledge of Utilization Review activities and importance of using Interqual. Manages the day-to-day operations working with the CDI and UR Supervisors on their respective areas of focus. Working knowledge of coding guidelines and the ability to apply coding guidelines, as well as coding clinic, when reviewing documentation in the medical record. Detailed knowledge of the format, functions, and use of the medical record. Detailed knowledge of MS DRG/APR DRG payment methodology. Detailed knowledge of SOI/ROM and Mortality measures. Responsible for managing an entire staff and completion of annual/other evaluations. Ability to supervise the work of others and communicate effectively. Provide education and one on one or groups settings. Assist the CDI Supervisor to resolve conflict between CDI and IP Coding discrepancies and working with Medical Staff directly as needed. Resolve conflict in accordance with Cox conduct policies. Licensure/Certification/Registration Required: MO RN License Preferred: CDIP or CCDS-
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