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HRTMS Job Description Management

RN Prog Dir, OP CDI

J  o  b    D  e  s  c  r  i  p  t  i  o  n

 

 

JOB INFORMATION

Effective Date:

12/13/2024

Entity:

Wisconsin

Job Code:

441010

Job Title:

RN Prog Dir, OP CDI

Exemption Status:

Exempt

Management Level:

Manager/Program Director

JOB SUMMARY

The RN Program Director – Outpatient CDI (OPCDI) is responsible for the leadership, direction and subject matter expertise in OPCDI and clinical risk adjustment. This includes strategic planning, executing, and monitoring of OPCDI programs, processes, and systems for accurate coding and risk adjustment across primary and specialty care. The RN Program Director will continuously monitor the goals and objectives of OPCDI while maintaining alignment with the strategic goals and objectives for UW Health. The incumbent collaborates with organizational leadership and staff to develop, analyze and assist with implementation of innovative solutions in a fiscally, operationally and professionally responsible manner.

 

The incumbent works dynamically and collaboratively with leadership from administration, clinical operations, finance, human resources, quality, clinical departments, APPs and physicians to evaluate, create, implement and monitor programs related to OPCDI.  The RN Program Director uses critical thinking skills to address opportunities for programmatic development and improvement while promoting engagement of stakeholders across multiple disciplines and departments.

 

The RN Program Director will lead and participate in systemwide OPCDI, coding and clinical risk adjustment committees and will partner with the physician leaders and other key stakeholders on all aspects of compliant and accurate risk adjustment documentation. Program Director will lead and/or support cross functional and enterprise-wide projects and initiatives. 

 

The incumbent requires excellent critical thinking skills; knowledge of Outpatient Perspective Payment System (OPPS)   and related medical record documents; broad-based clinical knowledge and thorough understanding of pathophysiology; as well as the ability to adapt to changes in the workload, to work independently and to effectively prioritize work assignments.

 

The incumbent represents the health system as an industry leader in OPCDI and risk adjustment by leveraging local, state, regional and national partnerships.

 


MAJOR RESPONSIBILITIES


Develop and implement outpatient CDI strategies and initiatives to improve the quality and accuracy of clinical documentation across the UW Health ambulatory care system.

 

Oversee the day-to-day operations cross functional leadership of the outpatient CDI and HCC coding programs

 

Establish program goals, performance metrics, and continuous improvement strategies.

 

Work closely with clinical leaders including physicians, nurse practitioners, and other healthcare providers to educate them on documentation best practices and the importance of accurate clinical documentation.

 

Lead both nurses and coding professionals to ensure that documentation supports coding and billing practices and adheres to coding guidelines and payer requirements.

 

Coordinate with other departments and stakeholders to integrate CDI practices into outpatient care workflows. Including but not limited to Clinical leadership, Population Health, Ambulatory operations, Revenue Cycle, Coding and Compliance.

 

Lead development of training programs for clinical staff on documentation standards, compliance requirements, and best practices.

 

Oversee ongoing education and support to ensure adherence to changes in regulations, coding guidelines, and documentation practices.

 

Monitor and analyze documentation and coding practices and outcomes to identify areas for improvement.

 

Lead and implement audits and reviews to assess the effectiveness of the CDI program and implement corrective actions as needed.

 

Utilize data and analytics to drive quality improvement initiatives and report on program performance.

 

Ensure the outpatient CDI program complies with all relevant regulations, including CMS, payer guidelines, and other industry standards.

 

Stay informed about changes in healthcare regulations and documentation requirements and update the CDI program accordingly.

 

Prepare and present reports on program performance, outcomes, and improvement initiatives to senior management and other stakeholders.

 

Communicate effectively with clinical and administrative staff to foster a culture of compliance and documentation excellence.

 


ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS.


Age Specific Competency (Clinical jobs only)

X

Clinical

 

(Select all that apply)


Age Specific Competency

Select all that apply

 

X

Infants (Birth - 11 months)

 

X

Toddlers (1 - 3 years)

 

X

Preschool (4 - 5 years)

 

X

School Age (6 - 12 years)

 

X

Adolescent (13 - 19 years)

 

X

Young Adult (20 - 40 years)

 

X

Middle Adult (41 - 65 years)

 

X

Older Adult (Over 65)


JOB REQUIREMENTS


Education

Education Level

Education Details

Required/
Preferred

 

Bachelor's Degree

in Nursing

 

Required

 

Master's Degree

in Nursing

 

Preferred

 


Work Experience

Experience

Experience Details

Required/
Preferred

 

4 years

of OP CDI experience, including two (2) years of progressively responsible leadership experience in OP CDI Risk adjustment (including training and provider education) 

Required

 

5 years

of OP CDI/HCC Risk adjustment experience, including partnering with physician leadership groups.

Preferred

 


Wisconsin Licenses & Certifications

Licenses/Certification Details

Time Frame

Required/
Preferred

 

Licensed as a Registered Nurse (RN) in the State of WI or holds a license issued by a jurisdiction that has adopted the nurse licensure compact

Upon Hire

Required

and

Certified Clinical Documentation Specialist – Outpatient (CCDS-O)

Upon Hire

Required

or

Certified Risk Adjustment Coder (CRC)

Upon Hire

Required

 

Certified Professional Coder (CPC)

 

Preferred

 


Required Skills, Knowledge, and Abilities

Maintain strong broad-based coding, CDI knowledge, and understanding of pathology/physiology of disease processes and expected health care outcomes to provide guidance to team members.

 

In-depth knowledge of HCC coding principles, risk adjustment methodologies, and healthcare documentation standards.

 

Experience with data analysis and the ability to use data to drive improvements in coding and documentation practices.

 

Proficiency in Microsoft Office Suite and familiarity with electronic health record (EHR) systems.

 

Exceptional critical thinking skills

 

Ability to lead cross functional projects with high organizational impact.

 

Official Coding and Clinical Documentation Guidelines

 

Knowledge of the principles and practices of leadership as applied to the management and direction of personnel.

 

Strong organizational, planning, scheduling and project management abilities

 

Excellent leadership ability

 

Excellent oral and written communication skills

 

Excellent analytical ability to develop and analyze data to recommend solutions and solve complex problems.

 

Ability to ensure a high level of customer satisfaction including employees, patients, visitors, faculty and other departments within UWHC/UWMF.

 

Excellent analytical skills

 

Excellent interpersonal skills

 

Ability to work independently as part of an interdisciplinary teams.

 

Ability to exercise good judgment.

 

Ability to work independently and self-motivate as well as motivate others.

 

Ability to meet deadlines.

 

Ability to problem solve and make independent decisions.

 


PHYSICAL REQUIREMENTS/WORKING CONDITIONS


 

Physical Demand Level

Occasional
Up to 33% of the time

Frequent
34%-66% of the time

Constant
67%-100% of the time

Sedentary: Ability to lift up to 10 pounds maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Although a sedentary job is defined as one, which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Up to 10#

Negligible

Negligible

Light: Ability to lift up to 20 pounds maximum with frequent lifting and/or carrying of objects weighing up to 10 pounds. Even though the weight lifted may only be negligible amount, a job is in this category when it requires walking or standing to a significant degree.

up to 20#

Up to 10# or requires significant walking or standing or requires pushing/pulling of arm/leg controls.

Negligible or constant push/pull of items of negligible weight

Medium: Ability to lift up to 50 pounds maximum with frequent lifting and/or carrying objects weighing up to 25 pounds.

20-50#

10-25#

Negligible-10#

Heavy: Ability to lift up to 100 pounds maximum with frequent lifting and/or carrying objects weighing up to 50 pounds.

50-100#

25-50#

10-20#

Very Heavy: Ability to lift over 100 pounds with frequent lifting and/or carrying objects weighing over 50 pounds.

Over 100#

Over 50#

Over 20#


Other - list any other physical requirements or bona fide occupational qualifications not indicated above:

 

Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.