Clinical Documentation Manager - Maitland, United States - AdventHealth

Description

**All the benefits and perks you need for you and your family:**

+ Benefits from Day One

+ Paid Days Off from Day One

+ Student Loan Repayment Program

+ Career Development

+ Whole Person Wellbeing Resources

+ Mental Health Resources and Support

**Our promise to you:**

Joining AdventHealth is about being part of something bigger. Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that **together** we are even better.

**Schedule:** Full Time **On Site and Hybrid -**

**S** **hift** : Monday Friday, 8am 5pm

**Location:** Orlando, 601 EAST ROLLINS STREET

**The community youll be caring for:**

+ Located on a lush tropical campus, our flagship hospital, 1,368-bed AdventHealth Orlando

+ We offer great benefits with immediate Health Insurance coverage

+ Career growth and advancement potential

+ Serves as the major tertiary facility for much of the Southeast, the Caribbean and South America

+ AdventHealth Orlando houses one of the largest Emergency Departments and largest cardiac catheterization labs in the country

+ We are already one of the busiest hospitals in the nation, providing service excellence to more than 32,000 inpatients and 125,000 outpatients each year

**The role youll contribute:**

The Clinical Documentation Integrity Manager is a Registered Nurse and/or a Registered Health Information Administrator with a high level of clinical proficiency necessary for the oversight of the Clinical Documentation team which is comprised of registered nurses and clinical documentation specialists. This role will oversee the review processes of complex patients that vary in age and have different developments in the acute and chronic disease states. Must have proven leadership and management skills that will promote effective and efficient review of physician documentation that supports the patient's level of care and develop action plans for improvement. Must have knowledge and job experience in management of processes, system implementations, and project management.

The Manager of Clinical Documentation works to strategically plan, organize, implement and evaluate the Compliant Documentation Management Program (CDMP) at AdventHealth. This includes management of the case mix index (CMI), length of stay (LOS), severity of illness (SOI) and risk of mortality (ROM) in cooperation with the Director of Clinical Documentation Improvement and all other operational hospital departments. The manager manages the Clinical Documentation Specialists (CDSs) in planning, implementing improvements, and re-evaluating processes to keep staff engaged and to assist in meeting department goals.

This role will oversee the review processes of complex patients that vary in age and have different developments in the acute and chronic disease states. Must have proven leadership and management skills that will promote effective and efficient review of physician documentation that supports the patients level of care and develop action plans for improvement. Must have knowledge and job experience in management of processes, system implementations, and project management.

The Clinical Documentation Manager will report directly to the Regional Clinical Documentation Director and will work extensively with CDI teams, physicians, Chief Medical Officers and Chief Nursing Officers of the current 6 hospitals in the North Florida Division in a matrix relationship to coordinate the efficient review and documentation capture of the underlying conditions that are supported by the physicians secondary review of the patient record, upon request of the clinical documentation team members.

Develops, assesses, plans, implements, and evaluates procedures and processes for the system, offers continuing education, process improvement, and change management. Is actively involved in future planning and strategic development for system CDI needs, to include policy development, program development, ongoing audits for the system level and campus level, and quality improvement efforts. Works under general supervision and utilizes critical thinking skills. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

**The value youll bring to the team:**

+ Maintains knowledge of all federal, state, and local documentation guidelines and communicates changes to all CDI staff; extensive knowledge of I10 and coding guidelines.

+ Develops, produces, and delivers training for CDI on an ongoing basis. This includes monthly New Hire CDI training, CDI Preceptor Program, and on an as needed basis for current employees in the CDI Department.

+ Responsible for the hiring process for CDI departments.Completes performance evaluations timely and is involved in employee counseling, coaching and termination per policy.Provides orientation for new employees and ensures compliance with department policy and procedure.

+ Maintains high levels of employee engagement and job performance by providing recognition and opportunities for learning. Ability to appropriately handle stress and interact with others.

+ Audits new CDI members during their 90 day probationary period. Presents written and verbal updates to the CDI Managers and the CDI Director. Provides additional education based on results of audit and provides input for the 90 Day Evaluation.

+ Supports the hospitals quality operating systems by generating and analyzing data and reports to identify opportunities for continuous growth and improvement; provides feedback to site-based teams and administrators, develops and implements action plans when appropriate.

+ Serves as support for the Clinical Documentation Improvement Director providing backup as necessary.Participates in job interviewing, assessment, and selection of new employees.Maintains positive morale maintenance with clinical documentation improvement and contributes to and promotes departmental performance improvement initiatives and employee engagement.Maintains confidentiality of employees, patients, and administrative and medical staffs information with no infractions and performs other duties as assigned.

Qualifications

**The expertise and experiences you'll need to succeed:**

**KNOWLEDGE AND SKILLS REQUIRED:**

+ Strong leadership skills

+ Strong critical thinking/problem-solving skills

+ Interpersonal skills that promote teamwork

+ Flexibility in prioritization

+ Ability to multitask

+ Ability to function in a stressful, fast-paced environment

+ Self-motivated and ability to work independently

+ Ability to motivate employees to attain program and organizational goals

+ Understanding of DRG assignments and metrics associated with the CDMP Program.

+ Understanding of coding guidelines for billing purposes

**EDUCATION AND EXPERIENCE REQUIRED** **:**

+ 4 or more years of Clinical Documentation Integrity Experience

+ Nursing Degree (RN, BS, BSN, or advanced degree) or Foreign Medical Graduate

+ 5 or more years of **acute clinical experience**

+ Experience with Microsoft Office (Excel, PowerPoint, and Word)

**EDUCATION AND EXPERIENCE PREFERRED** :

+ MSN

+ One or more years of coding experience

+ Knowledge of Cerner

**LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED** **:**

+ Current valid State of Florida or multi state license as a Registered Nurse **OR**

+ Current active State of Florida license as a Nurse Practitioner, Physician Assistant or MD

**LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED** **:**

+ CCDS

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

**Category:** Case Management

**Organization:** AdventHealth Orlando

**Schedule:** Full-time

**Shift:** 1 - Day

**Req ID:**

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.