RN CDI Quality Management Specialist

RN CDI Quality Management Specialist

Position Summary

Facilitates the improvement of the overall quality, completeness and accuracy of provider-based clinical documentation in the medical record. Performs retrospective reviews in Hospice, Mortality, Clinical Validity, Risk Adjustment and other quality concepts such as PSI, HAC and re-admission. Functions in a fast paced and continuously evolving department, working collaboratively with physician advisors, leadership within coding and billing, and other departments. Works directly with Clinical Documentation Integrity (CDI) leadership, but has the ability to function independently utilizing guidance provided.

Responsibilities

• Demonstrates ability to understand and explain complications and comorbidities (MCC/CC), severity of illness (SOI) and risk of mortality (ROM), mortality variables, case mix index (CMI), chronic and secondary conditions (HCC), impact of procedures, DRG calculation and imparts this knowledge to CDI staff, providers, and members of the healthcare team
• Performs with self-direction, independent decision-making, analytical teaching, and articulate communication skills, both verbal and written
• Performs retrospective review, analyzing the inpatient coding and medical record to identify coding opportunities and gaps in documentation, with a focus on quality variables such as mortality, readmission, risk adjustment, PSI, HAC, and denial prevention
• Composes compliant queries to providers to obtain clarification of the documentation, following compliant query practice guidelines
• Serves as a resource and participates in the ongoing education of clinicians and staff relating to physician query workflows, basic clinical documentation improvement concepts, coding guidelines and quality concepts, both written and verbal, to ensure that clinical information utilized in profiling and reporting is complete and accurate
• Accurately utilizes software systems to collect, track and report outcomes and maintain integrity of data collection. Analyzes data, creates reports, presentations and provides recommendations for process improvement to improve KH quality metrics to leadership
• Attends and participates in quality related committees as necessary
• Assists primary preceptor in fostering new CDS staff members on basic quality concepts, query compliance, daily workflows and coding guidelines as needed
• Assists and backs-up for concurrent, retrospective, and denial reviews
• Relies on experience and judgment to plan and accomplish goals
• Regular and predictable attendance is an essential job function
• Completes mandatory training requirements
• Performs other related duties as assigned
• Familiar with standard concepts, practices, and procedures within the field
• Competent to meet age specific needs of the unit assigned

Requirements and Minimum Qualifications

• Bachelor’s degree in nursing required; Master’s preferred
• State of Idaho Registered Nurse OR licensure pending as documented by temporary licensure OR current RN licensure from a state participating in the “multistate privilege to practice” compact with Idaho prior to start date
• Minimum 5 years’ acute care clinical experience required
• 3 years’ clinical documentation specialist experience required
• Certified Documentation Improvement Practitioner (CDIP) or Certified Clinical Documentation Specialist (CCDS) required
• Inpatient Coding background required
• Quality and/or leadership background preferred

Working Conditions

• Must be able to lift and move up to 20 lbs
• Must be able to stoop or crouch
• Must be able to reach arms above or below shoulder height
• Must be able to maintain a standing and/or sitting position
• Typical equipment used in a clinical job
• Remote Eligible

About Kootenai Health:

Kootenai Health is a highly esteemed healthcare organization serving patients throughout northern Idaho and the Inland Northwest. We have been recognized with many accolades and distinctions, including being a Gallup Great Workplace, No. 1 Best Place to Work in Large Healthcare Organizations, and Magnet™ Status for Nursing Excellence. We pride ourselves on our outstanding reputation as an employer and a healthcare provider.

As your next employer, we are excited to offer you:

• Comprehensive medical coverage, including fully employer‑paid options for eligible full‑time employees, plus affordable plans for part‑time staff. Benefits begin on the 1st of the month following 30 days of employment.
• Dental, vision, life, and pet insurance, with telemedicine and wellbeing resources available to all employees
• Tuition assistance after 90 days to support your professional growth
• Retirement plans with pre‑tax and Roth options and employer matching from 3%–6%
• Competitive pay, plus night, weekend, and PRN shift differentials
• Award‑winning wellness program with coaching, financial wellness resources, and free or discounted access to fitness centers and premium wellbeing apps
• PerkSpot discounts providing access to thousands of exclusive deals in over 25 categories
• And an employee referral bonus program

Kootenai Health provides exceptional support for extraordinary careers. If you want to work on a high-quality, person-centered healthcare team, we can't wait to meet you!

Apply today!

Kootenai Health complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, veteran status, or sex. Kootenai Health does not exclude people or treat them differently because of race, color, national origin, age, disability, veteran status, or sex.

RN CDI Quality Management Specialist

Job Code: 29206