Regional Manager, Clinical Documentation Integrity (Remote)

Trinity Health is one of the largest not-for-profit, Catholic health care systems in the nation. It is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians caring for diverse communities across 25 states. Nationally recognized for care and experience, the Trinity Health system includes 88 hospitals, 131 continuing care locations, the second largest PACE program in the country, 125 urgent care locations and many other health and well-being services. Based in Livonia, Michigan, its annual operating revenue is $20.2 billion with $1.2 billion returned to its communities in the form of charity care and other community benefit programs.

Work Remote Position Responsible for directing Clinical Documentation Integrity (CDI) activities for the Health Ministries (HM) in their defined region and day-to-day management of the CDI programs. Works with Director, CDI to ensure the program is in alignment with the Trinity Health CDI Program standards, polices, procedures, workflows. Uses available tools and reports to monitor CDS productivity, accuracy and compliance and will be responsible for addressing and refining processes to improve performance and achieve defined goals. Provides training and education to clinical documentation specialists (CDS) to enhance clinical and coding skill sets and optimal utilization of 3M CDI software. Analyzes data to determine educational opportunities and will create and provide training to documenting providers to improve documentation quality. Works closely with Regional and Local Health Physician Champions, Chief Medical Officers, HM Executive Leadership, clinical staff, coding and denials teams to facilitate documentation within the medical record and supports the patient’s severity of illness, risk of mortality, clinical validity and proper DRG assignment.

Knows, understands, incorporates and demonstrates the Trinity Health Mission, Vision and Values in leadership behaviors, practices and decisions. Ensures HM CDI Team compliance with Trinity Health CDI Program standards, polices, procedures, workflows, and CDI software standard use and adoption. Monitors system CDI Dashboard and HM CDI Monitoring Reports to identify opportunities for improvement and areas of focus for the HM CDI programs. Develops and implements action plans for program performance under target benchmarks. Understands and communicates appropriate clinical documentation and clinical validation to ensure that the severity of illness, risk of mortality and level of services provided are accurately reflected in the health record. Assists in overall quality, timeliness and completeness of the quality health record to ensure appropriate data, provider communication and quality outcomes. Serves as a resource for appropriate clinical documentation. Develops CDS team through hiring, maintaining work schedules, balancing workload and conducting performance evaluations. Mentors and coaches colleagues to ensure positive outcomes. Demonstrates a thorough understanding of the MS-DRG system, CCs/MCCs, impact on quality and CMI as well as ICD-10 coding systems and the guidelines related to Clinical Documentation Improvement. Serves as a resource for the CDS team for any of the above. Ensures that direct reports remain current in coding guidelines and other regulatory directives that impact CDI performance. Ensures all compliance and regulatory standards are met. Ensures that direct reports perform clinical validation as part of the review process and remain current on CDI strategies. Uses 3M/360 for entering and abstracting data related to CDI performance. Monitors the CDI Dashboard and reporting to identify opportunities for improvement and areas of focus. Communicates with and educates physicians and all other members of the healthcare team regarding clinical documentation, and monitors provider participation. Identifies learning opportunities for healthcare providers. Ensures that direct reports communicate, educate and engage with physicians and other members of the healthcare team regarding clinical documentation. Collaborates with coding leaders to assure documentation of diagnoses and co-morbidities are a complete reflection of the patient’s clinical status and care. Resolves all discrepancies in a courteous manner. Demonstrates expertise in problem-solving skills based on theoretical knowledge, clinical experience and sound judgment and serves as a professional role model by demonstrating desirable practice behaviors. Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health Corporate Integrity Program, Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.