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Position Summary: 

Beverly Hospital (BH) and Addison Gilbert Hospital (AGH) are located respectively in Beverly  and Gloucester, Massachusetts.  They are diverse community hospitals offering a range of services and are part of the Beth Israel Lahey Health System. The Clinical Documentation Integrity team is comprised of highly trained Clinical Documentation Specialists (CDS) that provide recommendations to physicians and other health care providers when key documenation is needed in themedical record to ensure an accurate, complete and compliant medical record.

The Manager of Clinical Documentation Integrity works to strategically plan, organize, implement, and evaluate the Clinical Documentation Integrity Program (CDI) at Beverly Hospital and Addison Gilbert Hospital.   This includes management of the case mix index (CMI), length of stay (LOS), Observed versus Expected mortality (O/E), minimizing DRG Clinical Validation denials and working collaboratively and cooperatively  with multiple hospital departments. These include but are not limited to:  Case Management, Utilization Review, Physician leaders, Health Information Management, Coding and the Performance Improvement departments.  The Manager directly oversees the Clinical Documentation Specialists (CDSs) in planning, implementing improvements, and re-evaluating processes to keep staff engaged and to assist in meeting department goals, and works collaboratively with the Denials Specialists.  

The Manager demonstrates a commitment to and performs in accordance with the philosophy, established policies, procedures, and standards of the Care Coordination department and the Hospital. Acts as a role model to staff members, promoting excellence in documentation integrity and improvement as well as CREAT E values and behaviors: Community, Respect, Excellence, Accountability, Teamwork and Empathy.

-Manages and develops CDS staff, motivating and supporting them to achieve a high level of CDS knowledge and job performance, including hiring new staff, coaching and counseling, and annual performance evaluations

-Accountability for CDI success, meeting key CDI metric goals such as query rates, capture reates, and movement toward correct principal diagnosis and case mix index

-Provides strategic oversight for CDS’s, developing a collaborative team and managing multiple priorities simultaneously

-Tracks CDI program success by establishing and reviewing key CDI metrics (operational, quality and performance) and develops action plans when there are opportunities to improve

-Implements workflows for 2nd level review for 3 major types of cases:  mortality reviews, hospice reviews, DRG mismatch reviews

-Manages reports and functions as a liaison for problem resolution with 3M360, Epic, Claro and home remote workstations as it relates to technology

-Member of the CDI Steering Committee providing ongoing feedback to the CDI team, physicians, administration

-Provides the CDI Executive summary,  and provider metrics to the MD Advisory Council as indicated

 -Member of the CDI Physician Advisory Council as an active participant working closely with the Physician Advisors on solutions to provider response concerns

-Works in conjunction with and collaboratively with CDI and coding leaders, and physician advisors to provide in-services and continuing education to the CDS tram, physicians, and clinical departments providing highly complex information to these audiences with a varied level of understanding of severity of illness and risk of mortality in an effort to ensure optimal reimbursement

-Works collaboratively with CDS team and denials specialists as needed to assist in coordinating and formulating responses to third party payer audits that result in DRG Clinical Validation denials and require appeals

-Uses critical thinking and sound judgment in decision making keeping reimbursement considerations in balance with regulatory compliance

-Assumes personal responsibility for professional growth, development, and continuing education to maintain a high level of proficiency

Licensure, Certification, Registration:

Current active State of Massachusetts licensed Registered Nurse, a Bachelor of Science degree in Nursing preferred

Certification as a Clinical Documentation Specialist preferred

Membership in a Clinical Documentation Integrity national organization required, such as ACDIS

Skills, Knowledge & Abilities:

-Extensive clinical knowledge and understanding of pathology/physiology with clinical experience in a hospital acute care setting

-Strong leadership skills inlcuding but not limited to

  Able to motivate colleagues to attain program and organizational goals

  Ability to promote teamwork

  Flexibility and able to pivot priorities

  Achieve program goals and objectives

-Ability to function in a highly impactful, fast paced environment 

-Excellent written and verbal communiction

-Subject matter expert with a full understanding and working knowledge of DRG assigments and metrics

-High level understanding of and working knowledge of coding guidelines for compliance purposes

-Ability to prepare, analyze and present data

Experience:

Minimum of 5 years of progressive CDS experience, including at the  supervisory/managerial level and/or an actively involved in program development

FLSA Status:

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more about this requirement.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled