RN Manager of Clinical Documentation Improvement | Master's Degree Required

Washington, DC, United States

Job Description - RN Manager of Clinical Documentation Improvement | Master's Degree Required (240001GN)

Job Description

RN Manager of Clinical Documentation Improvement | Master's Degree Required - ( 240001GN )

Description

Description This position will manage activities and staff of the Utilization Review and Clinical Documentation Improvement departments.

Supervise and evaluate the daily work of these teams in accordance with departmental and organizational policies. Provide education within the departments and the organization at large on clinical care, levels of care, and financial issues. Analyze and report data related to case management activities, payer activities, resource utilization, and clinical denials. Lead hospital wide initiatives on behalf of the department.

Monitor the performance, collection and analysis of data to report on the effectiveness of process improvement to the organization and department. Participate in the planning, development and implementation, and ongoing success of the Clinical Documentation Management Program. Educate members of the patient care team regarding documentation guidelines, including attending physicians, nursing, and other interdisciplinary team members.

Qualifications

Qualifications Minimum Education

Master's Degree (Required)

Minimum Work Experience

7 years Healthcare experience (Required)

3 years Supervisory experience (Required)

Required Skills/Knowledge

Facile with keyboarding and familiar with software such as Windows environment (i.e., Microsoft Office, Word, PowerPoint, Excel, Access).

Excellent oral and written communication skills. Knowledge of children's health issues.

Knowledge of cultural issues and their impact on health care. Strong focus on Service Excellence.

Working experience with medical management criteria such as Milliman and/or Interqual.

Ability to analyze and present productivity and outcome data using Microsoft Access and Excel.

Required Licenses and Certifications

Registered Nurse in District of Columbia (Required)Basic Life Support for Healthcare Provider (BLS) (Required)

CCDS or CDIP (Preferred)

Case Management Certification (CCM or CMSA) (Preferred)

Functional Accountabilities

Operations Management - General

Supervise and evaluate the daily work in accordance with departmental and organizational policies.

Manage staffing to ensure adequate coverage and optimize productivity. Assign coverage and deploy staff accordingly.

Participate in budget development and recommend budgets for areas of oversight.

Track spending for areas of oversight.

Operations Management - Clinical Resource Management (CRM)/Utilization Review (UR)

As a subject matter expert on Interqual and MCG guidelines, function as a resource to staff and intervene to resolve issues that arise internally and with payors.

Mentor staff and support learning opportunities to foster success.

Work directly with payors and Managed Care to enhance communication and improve authorization processes.

Assist with the management of denials and High Risk cases.

Operations Management - Clinical Documentation Improvement (CDI)

Partner with coding leadership to monitor trends and mismatches between CDI and coding and strategize about ongoing process improvement.

Ensure Clinical Documentation Specialists and Coders are educated on organizational initiatives and professional trends in practice.

Target improvement activities to specific payers, DRGs, and teams based on financial and clinical data analysis.

Assist in the development and reporting of performance measures to the medical staff and/or healthcare teams; prepare physician specific-data reports.

Facilitate change process required to capture needed documentation such as template/forms design.

Develop ongoing physician/provider education strategies in collaboration with other Revenue Cycle Departments to promote complete and accurate clinical documentation and correct negative trends.

Monitor CDS assignment in 3M/360 and review Account Validation.

Relationship Building/Information Sharing

Establish and maintain effective internal and external relationships to optimize achieving departmental and organizational goals.

Provide information to Case Managers and Clinical Documentation Specialists on organizational initiatives and professional trends in practice.

Represent CRM and CDI on organizational committees.

Performance Improvement/Outcomes Management

Ensure Case Management and Clinical Documentation Improvement activities are in regulatory compliance (JC, CMS).

Track clinical, functional, operational, quality and financial data related to CRM and CDI.

Collect and analyze data on program efforts and outcomes; identify patterns, trend variances, and opportunities to improve documentation review and process.

Implement processes to continually improve performance, reduce denials, and optimize reimbursement.

Update Departmental procedures to reflect changes in payor contracts and departmental processes.

Organizational Accountabilities

Organizational Accountabilities (Staff)

Organizational Commitment/Identification

Teamwork/Communication

Performance Improvement/Problem-solving

Cost Management/Financial Responsibility

Safety

Primary Location Primary Location : District of Columbia-Washington

Work Locations Work Locations : CN Hospital (Main Campus) 111 Michigan Avenue NW Washington 20010

Job Job : Management

Organization Organization : Finance

Position Status : R (Regular) - FT - Full-Time

Shift : Day

Work Schedule : M-F 0830-1700

Job Posting Job Posting : May 28, 2024, 7:52:58 PM

Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law. The “Know Your Rights” poster is available here: and the pay transparency policy is available here:Know Your Rights Pay Transparency Nondiscrimination Poster.

Please note that it is the policy of Children's National Hospital to ensure a “drug-free” work environment: a workplace free from the illegal use, possession or distribution of controlled substances (as defined in the Controlled Substances Act), or the misuse of legal substances, by all staff (management, employees and contractors). Though recreational and medical marijuana are now legal in the District of Columbia, Children's National and its affiliates maintain the right, in accordance with our policy, to enforce a drug-free workplace, including prohibiting recreational or prescribed marijuana.

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