Overview

Position is responsible for the Clinical Documentation Program and the Clinical Documentation team of Registered Nurses. The CDI Director will work with the CDI Physician Advisor, clinicians, coders, and all members of the healthcare team to ensure program success and timely and accurate clinical documentation within medical records.

 

Job Description

 

Director, Clinical Documentation is responsible for the Clinical Documentation Integrity (CDI) across all hospitals. The CDI Director will work with all members of the healthcare team to ensure timely and accurate clinical documentation within medical records. The ideal candidate should have:

CDI leadership experience highly preferred

Acute hospital nursing experience highly preferred

Critical Care nursing experience preferred

Understanding of Quality

Experience working with Vizient rating system

Must meet all the following Minimum Qualifications to be considered

Minimum Qualifications

 

Education: Bachelor of Nursing

 

Licenses/Certifications: Current licensure as an RN; CCS or Coding experience desirable

 

Experience / Knowledge / Skills:

 

 

 

Minimum of five (5) years in acute care and clinical documentation as well as recent leadership experience

Advanced clinical expertise and extensive knowledge of complex disease processes with a broad clinical experience in an inpatient setting

Demonstrated leadership skills

Excellent verbal, writing and presentation skills

Solid understanding of Quality Improvement process

Proficiency in negotiation of complex systems to effect change

Proficiency in computer usage including database and spreadsheet analysis

Understanding of organizational policies and procedures as well as extensive knowledge of regulatory systems

Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on our brand promise of “we advance health” through innovation, accountability, empowerment, collaboration, compassion and results.

Principal Accountabilities

 

 

 

Accountability for success of the CDI program; track and trend productivity and success.

Day to day oversight of the program.

Direct the CDI process flow.

Provide CDI Team, physicians and administration ongoing feedback.

Perform staff evaluations.

Provide necessary feedback and conflict resolution to the CDI Team.

Collaborate with Physician Liaison regarding physician resistance to the program and develop an action plan to address this if it occurs.

Schedule and lead monthly Staff meetings.

Contributes to a positive working environment and performs other duties as assigned or directed to enhance the overall efforts of the organization.

Develops physician education strategies to promote complete and accurate clinical documentation and correct negative trends.

Assists with special projects as needed.

Performs other duties as assigned.

Participates in assigned committees as appropriate.

Ensures safe care to patients, staff and visitors; adheres to all policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

Other duties as assigned.