Clinical Documentation Integrity (CDI) Review

Location

United States

Posted

9 days ago

Salary

0

Seniority

Mid Level

No structured requirement data.

Job Description

Clinical Documentation Integrity (CDI) Review

CareConnectMD Inc

Role Description The Clinical Documentation Integrity (CDI) Reviewer is responsible for reviewing clinical documentation to ensure it accurately reflects the patient's clinical condition and supports complete, compliant, and specific documentation. Leveraging knowledge of ICD-10, CPT, and other applicable coding guidelines, this role helps optimize risk adjustment, reimbursement, quality reporting, regulatory compliance, and clinical data integrity while partnering with providers, clinical teams, and operational leadership to improve documentation quality. Key Duties and Responsibilities - Review high-acuity patient medical records to identify clinical indicators, documentation gaps, and suspect diagnoses that may impact quality outcomes, risk adjustment, and reimbursement. - Analyze medical records to determine appropriate clinical information and identify opportunities for accurate diagnosis capture and documentation improvement. - Implement and execute clinical data review strategies in alignment with established protocols, program requirements, and organizational standards. - Ensure consistency, accuracy, and adherence to documentation review methodologies within assigned protocols while contributing to the development and implementation of new review processes. - Utilize clinical expertise and coding knowledge to identify opportunities for enhanced documentation accuracy, completeness, and specificity. - Collaborate with risk adjustment, case management, quality, and provider teams to ensure clinical documentation accurately reflects patient conditions, treatment decisions, and diagnoses. - Leverage physician query and communication processes to clarify documentation and improve the quality and completeness of the medical record. - Identify and validate suspect diagnoses using clinical evidence and documentation standards. - Communicate clinical documentation requirements, coding guidelines, and regulatory standards to providers, coders, leadership, and other stakeholders. - Support coding validation efforts by ensuring documentation supports reported diagnoses and conditions. - Assist with provider and staff education regarding documentation improvement, coding compliance, risk adjustment methodologies, and diagnosis capture initiatives. - Maintain comprehensive tracking and management systems for assigned medical record reviews, findings, and outcomes. - Generate reports and communicate findings resulting from chart reviews to leadership and relevant stakeholders. - Monitor and maintain productivity, quality, and accuracy standards as defined by organizational performance metrics. - Ensure all activities comply with HIPAA regulations, CMS guidelines, payer requirements, and organizational policies. - Participate in internal audits, quality assurance activities, and process improvement initiatives. - Maintain current knowledge of clinical documentation integrity practices, coding regulations, and industry best practices. - Perform other duties, special projects, and responsibilities as assigned. Qualifications - RN or NP/PA and a minimum of 3 years of progressive clinical experience. - At least two (2) years of experience in chart review for clinical indications of medical conditions and diagnosis and management options with emphasis on the managed care industry. - Coding certification is preferred but not required. - Strong understanding of ICD-10-CM coding guidelines, clinical documentation improvement principles, and physician query processes. - Experience reviewing provider documentation in outpatient, ambulatory, post-acute, primary care, or value-based care settings preferred. - Experience in working with various electronic health records (EHR) and medical records. Essential Skills and Abilities - Strong clinical knowledge related to chronic illness diagnosis, treatment, and management. - Familiarity and understanding of CMS HCC models, Risk Adjustment coding and data validation requirements (preferred). - Working knowledge of ICD-10-CM outpatient diagnosis coding guidelines. - Proficient in Microsoft Office Suite (Excel, Word, PowerPoint, Outlook) and other business applications, with strong spreadsheet and reporting skills. - Ability to review and analyze medical records across multiple EMR/EHR platforms. - Strong critical thinking, analytical, and problem-solving abilities. - Knowledge of ICD-10, clinical documentation standards, risk adjustment, and HIPAA compliance. - Excellent written and verbal communication skills with the ability to educate and collaborate with providers and interdisciplinary teams. - Ability to manage multiple priorities and meet strict deadlines in a fast-paced environment. - Self-motivated with the ability to work independently and remotely while maintaining productivity and accuracy. - Strong organizational skills, attention to detail, and commitment to confidentiality. - Ability to establish effective working relationships across departments, locations, and time zones. - Reliable, adaptable, and capable of handling sensitive information with professionalism and discretion. Core Competencies - Instills trust - Customer focus - Manages ambiguity - Collaborates - Drives results

Related Categories

Related Job Pages

More Clinical Research Jobs

Professional Case Management - PCM logo

Registered Dietitian Clinical Research - PRN

Professional Case Management - PCM

Professional Case Management - PCM is a healthcare company on a mission to provide outstanding care and other services in the healing environment of patients’

Title: Registered Dietitian Clinical Research - PRN Location: GA - Atlanta Job Description: Make a Difference on Your Own Schedule and Terms! Hiring Per Diem Registered Dietitians for Virtual Visits! EmVenio Research provides quality, in-home clinical trial visits for various Sponsors and CROs. We're the only company that hires, trains, certifies, tests, and manages our own Registered Dietitians. Our mission is to bring clinical trial visits to subjects wherever they may be to increase convenience and compliance with study protocols. Be part of a team who fully embrace our values and key behaviors! - We work as a team - We do the right thing - We figure it out - We pursue growth - We take ownership Why work for EmVenio? - We bring research to every neighborhood — making it more accessible, more inclusive, and more human — so every community can share in the promise of better care. - Be a member of our general staffing pool - No research experience required, on the job training provided - Gain Certification through GCP training Required Qualifications - Bachelor’s degree from an accredited dietetics program (If CDR examination was before January 1, 2024) - Graduate degree from an accredited dietetics program (If CDR examination was on or after January 1, 2024) - Registered Dietitian (RD) or Registered Dietitian Nutritionist (RDN) Certification by the Commission on Dietetic Registration (CDR) - Current State Dietitian License/Certification in good standing (if applicable) Job Specific Details: - Performs the full scope of Registered Dietitian practices; including, but not limited to, providing virtual lifestyle counseling visits to improve nutrition and dietary quality, mental health and developing coping skills, and building health behavior and lifestyle habits that align with participant’s goals and values. - Sets appointments with subjects within the required appointment window. - Completes virtual visits for clinical trial subjects. - Works cooperatively with Clinical Project Manager and site personnel to complete visits and submit accurate source documents in a timely manner. - Regularly stay informed on the latest nutrition and food health updates. - Performs additional duties and responsibilities as deemed necessary. Standard Rate: $42.00 Hourly plus commute, mileage, training, and administrative pay. Please contact Ashley Sin at (303) 317-5486 x486 or at ashley.sin@emvenio.com today to learn more about our opportunities where you can make a difference in your own career! Professional Case Management is an Equal Opportunity Employer.

Georgia
$0 / hour
Full TimeRemoteTeam 501-1,000Since 2011H1B No Sponsor

Role Description Provide integrated support to patients and physicians by providing a "hands-on" approach to improve the quality of patient care. This is accomplished by developing personalized relationships with patients and prescribers to improve medication adherence and promote evidence-based care. - Reviewing and interpreting clinician's patient care note/assessments for supportive clinical data needed for prior authorization approvals and development of care plan recommendations. - Develop and refine disease and drug specific clinical protocol to maximize patient adherence and promote evidence-based cost-effective care. - Monitor on-going patient adherence (PDC reports, patient assessment data, and mobile platform data) across all sites and disease categories with focus on oncology and other specialty specific disease states. - Evaluation of EMR to review: drug and disease interaction, medication selection, labs/vitals, allergies, RX orders/renewals and direct MD communication, and other relevant information important to maximize medication adherence and optimize patient outcomes. - Recommending alternative therapeutic drug regimens and disease specific treatments according to guidelines as appropriate. - Monitor and evaluate therapies for side effects or other medication related issues, recommend drug therapy changes to prescribers as appropriate. - Medication therapy management (MTM): including reviewing and monitoring of medication regimens, advising clinicians on evidence based therapy as indicated, documenting interventions; assessing patient adherence rates. - Clinical interventions including but are not limited to comprehensive pharmacist consultation, motivational interviewing/coaching, drug regimen optimization, medication reconciliation, medication lists or reminders, medication synchronization, coordinate home nurse visits, transitions between liaison/PSC, use of mobile app or other technologies. - Productivity monitoring and reporting weekly stats for growth development. - Overseeing tech's daily activities and verification for accuracy on: delivery coordination slips, prior authorizations submitted, ongoing PA log activity and proactive management care utilization within each specialty as per protocol. - Identifying and resolving insurance related issues, recognizing situations where financial assistance can be applied. - Supervising communication of support personnel compliant with HIPPA rules and regulations. - Maintaining current registration and all remote pharmacist activity to comply with local, state and federal drug laws as regulated by each state board of pharmacy and the DEA. - Direct communication with other health professionals as necessary regarding patient care. - Develops own knowledge by participating in education programs; training pharmacy staff, students, interns, externs, and health care professionals. - Manage, organize, and update relevant data using database applications. - Apply observations and recommendations to operational issues, increased productivity, quality, and customer-service standards. - Assist with research projects and peer reviewing articles as needed. - Identify trends, resolves problems; recommend improvements; implements change. - Actively participates in process improvement initiatives. - Protects organization's value by keeping information confidential. - Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations. - Willing to do whatever is necessary for the betterment of the Company. - Other duties as assigned. Qualifications - Analyze information, exercise good judgment, possess strong verbal and written communication skills. - Deep knowledge of specialty medication pharmacology, local/state/federal pharmacy regulations. - Able to manage processes, exhibit strong technical and clinical skills. - Excellent leader and manager of people, constant focus on legal compliance. - Highly productive, quality focused and attention to detail. - Must be computer literate with proficiency and working knowledge of database and reporting tools such as: Microsoft Word, Excel, and PowerPoint. - Knowledge using EPIC/QS1/WILLOW software a plus. - Ability to identify barriers to medication adherence and implement and monitor plans to improve medication adherence. - Ability to motivate and coach patients to help them achieve better outcomes and identify goals of therapy. Traits - Organized - High-integrity - Attention to detail - Dependable - Quality focus - Empathetic - Good listener/communicator Other - Energetic, highly motivated, team player with strong personal and communication skills. - Discretion and confidentiality essential as position deals with highly sensitive and private data. Specialties - Knowledge of complex/chronic diseases states and therapies used within specialty pharmacy: Oncology, Transplant, Hepatitis C, Infectious Disease (including HIV), Multiple Sclerosis, Rheumatoid Arthritis, GI disorders (including IBD), Cystic Fibrosis, Psoriasis, Hyperlipidemia and many various inflammatory conditions (including Lupus) preferred. Experience/ Education - Required Licensure/Certification: Applicant must hold a Doctor of Pharmacy (PharmD) or equivalent advanced degree and be a licensed Pharmacist. - Years of Experience: 1+ years' experience is strongly preferred but not required. Should additional licensure need to be obtained, the applicant will commit to obtaining the required licensure within a mutually agreed upon timeframe. Continued employment is contingent upon meeting these requirements. - Education: PharmD or equivalent advanced degree required.

United States
Professional Case Management - PCM logo

Bilingual Registered Dietitian Clinical Research - PRN

Professional Case Management - PCM

Professional Case Management - PCM is a healthcare company on a mission to provide outstanding care and other services in the healing environment of patients’

Bilingual Registered Dietitian Clinical Research - PRN Location: New York Job Description: Make a Difference on Your Own Schedule and Terms! Hiring Per Diem Bilingual Registered Dietitians for Virtual Visits! Must be fluent in Spanish/English. EmVenio Research provides quality, in-home clinical trial visits for various Sponsors and CROs. We're the only company that hires, trains, certifies, tests, and manages our own Registered Dietitians. Our mission is to bring clinical trial visits to subjects wherever they may be to increase convenience and compliance with study protocols. Be part of a team who fully embrace our values and key behaviors! - We work as a team - We do the right thing - We figure it out - We pursue growth - We take ownership Why work for EmVenio? - We bring research to every neighborhood — making it more accessible, more inclusive, and more human — so every community can share in the promise of better care. - Be a member of our general staffing pool - No research experience required, on the job training provided - Gain Certification through GCP training Required Qualifications - Bachelor’s degree from an accredited dietetics program (If CDR examination was before January 1, 2024) - Graduate degree from an accredited dietetics program (If CDR examination was on or after January 1, 2024) - Registered Dietitian (RD) or Registered Dietitian Nutritionist (RDN) Certification by the Commission on Dietetic Registration (CDR) - Current State Dietitian License/Certification in good standing (if applicable) Job Specific Details: - Performs the full scope of Registered Dietitian practices; including, but not limited to, providing virtual lifestyle counseling visits to improve nutrition and dietary quality, mental health and developing coping skills, and building health behavior and lifestyle habits that align with participant’s goals and values. - Sets appointments with subjects within the required appointment window. - Completes virtual visits for clinical trial subjects. - Works cooperatively with Clinical Project Manager and site personnel to complete visits and submit accurate source documents in a timely manner. - Regularly stay informed on the latest nutrition and food health updates. - Performs additional duties and responsibilities as deemed necessary. Standard Rate: $50.00 Hourly plus commute, mileage, training, and administrative pay. Please contact Ashley Sin at (303) 317-5486 x486 or at ashley.sin@emvenio.com today to learn more about our opportunities where you can make a difference in your own career! Professional Case Management is an Equal Opportunity Employer.

New York
$0 / hour
Care Access logo

Registered Nurse, Clinical Delivery

Care Access

Care Access is revolutionizing clinical research by bridging the gap between patients, providers, and groundbreaking treatments. Founded with a mission to make clinical trials more

Role Description The Registered Nurse, Clinical Delivery (RN) in this role will manage the communication of critical and abnormal lab results to patients, ensuring compliance with state licensure requirements. This includes: - Contacting patients and documenting communications - Following up on lab escalations - Collaborating with providers to ensure all patient interactions are appropriately managed and documented - Providing patient education on lab results and necessary next steps in care - Serving as a point of escalation for the Member Services team - Liaising with the Clinical Conduct Team to resolve issues related to lab results - Assisting in training and educating the Member Services team This role is critical in ensuring timely patient communication and maintaining compliance with clinical and legal standards. This is a part-time position. Qualifications - Strong analytical capabilities - Exceptional communication skills - Commitment to fostering a patient-centered environment - Strong attention to detail - Ability to manage multiple patients efficiently - Ability to work independently while collaborating with a larger clinical team Requirements - Active RN licensure with a commitment to compliance and regulatory standards - Compact Licensure required; additional licenses may be required - BSN or equivalent degree preferred - Minimum of 3 years of experience as a working nurse, clinical research, medical communications, and/or related field - Proficiency in Salesforce or other EMR systems for documenting patient interactions - Willingness to maintain and obtain additional state licenses as needed Benefits - Remote work within the United States - Structured on-call system for coverage - Less than 10% travel requirements - Expected pay range: $34.00 - $48.00 USD per hour for full-time team members Company Description Care Access is working to make the future of health better for all. We bring world-class research and health services directly to communities that often face barriers to care. We are dedicated to ensuring that every person has the opportunity to understand their health, access the care they need, and contribute to the medical breakthroughs of tomorrow. - Programs like Future of Medicine and Difference Makers - Partnerships, technology, and perseverance to reimagine clinical research and health services

United States
$34 - $48 / hour