Director, Clinical Documentation Integrity

The Director of Clinical Documentation Integrity will be an integral part of ArchWell Health's Quality Team. The Director of Clinical Documentation Integrity is responsible for leadership of all Clinical Documentation Integrity activities of the organization including prospective clinical chart reviews, suspecting workflows, training, analysis of trends, and strategy for improvement. The Director of Clinical Documentation Integrity will manage key vendor relationships including coding, quality assurance, external audits, education, and suspecting. This role will also provide leadership and oversight to the CDI team as well as support all clinical education activities at ArchWell Health that improve value-based care over multiple markets and states in an outpatient senior-focused primary care setting.

• Provide leadership of CDI team, including oversight of QA and productivity
• Maintain onboarding workflows for RN and Provider CDI activities
• Participate in new provider onboarding clinical education and all-provider clinical educational events as needed.
• Dyad with Physician Advisor for maintenance of training decks and didactic education calendar.
• Analyze educational trends and develop strategy for CDI deployment and educational activities.
• Build relationships with market primary care teams and market leaders.

• Identify educational opportunities at the center and market level and collaborate closely with clinical leadership and operations regarding improvement plans.
• Work with the EHR and IT systems to ensure appropriate diagnosis, clinical quality data, and care plans are documented appropriately.
• Meet regularly with the internal Compliance team on documentation and coding compliance and audit activities
• Manage vendor relationships including coding, audit teams, IT solutions for suspecting, and supplemental education
• Partner with internal Data and IT teams on end-user experience of point of service tools

• Advanced knowledge of ICD-10, CPT, and HCPCS codes
• Medicare Advantage experience including knowledge of the current HCC model and STARs ratings
• Proficient with Microsoft Office Suite products including Word, Excel, Power Point, and Outlook, and Teams
• Ability to travel to visit centers markets at the national level to provide clinical education and coaching
• Demonstrated strong leadership and team building skills
• Experience in clinical process improvement
• Ability to create, plan, implement and evaluate patient specific care plans
• Excellent presentation, verbal, and written communication skills
• Ability to exercise use of independent judgement
• Sensitivity to the diverse needs of culturally diverse staff, patients, and communities
• Experience in development and maintenance of guidelines and clinical policies

Minimum Qualifications:

• A valid, active Registered Nurse (RN) license in State of employment required
• A minimum of 2 years clinical work experience
• A minimum of 5 years' experience with CDI in a Medicare Advantage environment, including 2 years of leadership experience
• CRC or CCACP certification preferred
• Experience with Electronic Medical Records

• Embodies and serves as a role model of ArchWell Health's Values:

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  • Be compassionate
  • Strive for excellence
  • Earn trust
  • Show respect
  • Stay resilient
  • Always do the right thing
  
  
  
  

About ArchWell Health:

At ArchWell Health, we're creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship, routine wellness, and staying active, our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard, listened to, and given ample time by their physicians to live well later in life.

Our value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable, accessible neighborhood centers where older adults can feel at home and become part of a vibrant, wellness-focused community. We're passionate about caring for older adults and united by the belief that caring has the power to change everything for our members.

ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.