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Manager Clinical Documentation Integrity and Education

Cape Cod Healthcare

Hyannis, MA
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Cape Cod Healthcare
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Job Details

Cape Cod Healthcare

Department: Case Management
Schedule: Full-time 40 Hours per week
Shift: Day Shift
Hours: 8a-4:30p Monday-Friday occ w/e&hol *FUTURE OPPORTUNITIES*
Job Details:

Job description reflects shared duties with Falmouth Hospital as well. 



The Manager of Clinical Documentation Integrity is responsible for the day to day operations and clinical management of the CDI program staff, oversees the overall CDI review processes and maintains the integrity of the daily operations. This position is also responsible for developing and conducting ongoing education for CDI and CM/SW staff. 



1.     Day to day management of the clinical documentation integrity program staff and workflows

2.     Active collaboration with Director, HIM, Quality and Revenue Cycle teams to facilitate highest quality clinical outcomes and revenue capture.

3.     Ongoing development and completion of continuing education programs for Clinical Resources Management staff, including CDI, case managers and social workers specifically related to role functions and implementation of new processes.

4.     Provides ongoing Clinical Documentation management program education for new staff, including new Clinical Documentation Registered Nurses, physicians, nurses and allied health professionals.

5.     Tracks and trends program compliance.

6.     Develop, mentor and coach continual improvement in the collaborative practice between physicians and CDI's.

7.     Remains current with coding information to ensure accuracy of codes assigned based on documentation.

8.     Assists coders' when querying physicians regarding unclear documentation

9.     Analysis and review of program metrics

10.  Extensive knowledge of treatment methodology, patient care assessment, data collection techniques and coding classification systems

11.  Knowledge of organizational policies and procedures,

12.  Skill in identifying problems and recommending solutions.

13.  Skill in preparing and maintaining records and written reports

14.  Understand and communicate differences between Medicare Part A and Part B guidelines and how they impact DRG assignments

15.  Understands commercial insurer requirements re: CDI and completes review of medical records appropriate to those requirements

16.  Provides coverage for the Manager of Case Management


Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers in a manner that reflects Cape Cod Healthcare's commitment to CARES: compassion, accountability, respect, excellence and service.



  • Extensive knowledge of clinical documentation integrity, professional education concepts and program development interaction with physicians, HIM professionals, and nursing staff.
  • Bachelor level degree in Nursing required.  Masters Degree preferred
  • Current Massachusetts Registered Nurse license
  • Certification in clinical documentation integrity preferred
  • Minimum of two years experience in direct nursing care, preferably including intensive care nursing with expert knowledge of pathophysiology and disease process
  • Two years experience in process improvement; experience in IDC-9, ICD-10, CDI, coding, utilization review or other relevant area
  • Experience in development and presentation of professional continuing education programs
  • Knowledge and orientation to ICD-10
  • Knowledge of CMS regulations, including Medicare A and B
  • Excellent computer skills – familiarity with Windows based software programs
  • Organizational, analytical, writing and interpersonal skills
  • Management/supervisory experience preferred
  • ***Must successfully complete or have completed a JATA Clinical Competency Exam*** prior to interview process

HR Use Only:

Zip Code: 02601
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