Director-Clinical Documentation and Quality Utilization

Benefits

• $10,000 Tuition Reimbursement per year ($5,700 part-time)
• $10,000 Student Loan Repayment ($5,000 part-time)
• $1,000 Professional Development per year ($500 part-time)
• $250 Wellbeing Fund per year($125 for part-time)
• Matching 401(k)
• Excellent medical, dental and vision coverage
• Life insurance
• Annual Employee Salary Increase and Incentive Bonus
• Paid time off and Holiday pay

Northwestern Medicine is powered by a community of colleagues who are purpose-driven and committed to our mission to deliver world-class care. Here, you'll work alongside some of the best clinical talent in the nation leading the way in medical innovation and breakthrough research with Northwestern University Feinberg School of Medicine.

We recognize where you've been, and we support where you're headed. We celebrate diverse perspectives and experiences, which fuel our commitment to equity and culture of service.

Grow your career with comprehensive training and development opportunities, mentorship programs, educational support and student loan repayment.

• Create the life you envision for yourself with flexible work options, a Reimbursable Well-Being Fund and a Total Rewards package that support your physical, mental, emotional and financial well-being.
• Make a difference through volunteer opportunities we offer in local communities and drive inclusive change through our workforce-led resource groups.

From discovery to delivery, come help us shape the future of medicine.

Description

The Director, Clinical Documentationand Quality Utilization reflects the mission, vision, and values of Northwestern Medicine (NM), adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

The Director is responsible for leading the system function of Clinical Documentation Responsible for managing relationships with key stakeholders at multiple business units to advance financial and quality outcomes for Northwestern Medicine (NM), as well as specific goals within local operating unit, Regional Medical Group (RMG) and/or Northwestern Medical Group (NMG).

The Director partners with other NM leaders to design, develop, plan and implement clinical documentation integrity efforts targeted at delivering innovative, timely, and accurate documentation across all entities. Functional areas of responsibility include monitoring internal and external performance and benchmarking data to identify priorities and implement strategies for improvement/accuracy. Responsible for identifying, developing, and implementing key strategies to leverage the electronic health record (EHR) and other tools to facilitate accurate representations of patient acuity, severity of illness, medical necessity, and risk adjustment within the medical record. Responsible for creating and monitoring a compliant oversight process related to coding/documentation/query best practices. Responsible for the design evaluation, maintenance and oversight of process and outcome metrics and the design, implementation, and maintenance of a reporting and communication process to key stakeholders.

Key to this role is the ability to evaluate, design, lead, and implement an aligned approach to clinical documentation integrity processes across NM as well as the ability to cultivate and maintain relationships with key stakeholders at all NM facilities. Requires extensive travel to support the business needs of Northwestern Medicine.

Reports to Vice President, Clinical Documentation

Responsibilities:

• Responsible for providing leadership to a portfolio of projects/ initiatives through active engagement of stakeholders and leading teams to outcomes which support the advancement of the NMHC Strategic Plan.
  • Key stakeholders include Business Unit and System Presidents and other members of the Senior Leadership Team, Value-Based Care Leadership, Care Coordination Leadership, Clinical Documentation Managers and Medical Directors, Quality Utilization Managers and Medical Directors, and the Physician and Advanced Practice Provider (APP) members.
  • Scope includes all functions which support documentation within the patient’s medical record. 
  • Scope includes all practitioners, clinicians and others participating in delivering or supporting patient care, including those privileged through the medical staff, trainees, students, employees, volunteers.
• Partner with Key Stakeholders (as above), as well as Clinical Quality, Coding, Corporate Integrity and Compliance, Social Work, Health Information Management (HIM), Patient Access, Analytics, EPIC IT, and other leaders to understand the national quality agenda, the annual system and regional key initiatives, the Inpatient Quality Composite goals, annual employee goals, and other business unit and system improvement initiatives to incorporate such goals, monitoring, and action plans into the annual Clinical Documentation Quality Integrity plan as appropriate. 
• Create and maintain annual quality plans
• Partner with the NMH Chief of Staff appointee and Chairperson of the NMH Quality Utilization Committee to lead the committee oversight of activities related to the review of all patients of all payer backgrounds with respect to the medical necessity of admissions to the hospital, the length of stay, and the hospital-based services rendered which include medications and biological treatments.
• Responsible for understanding the current and long-range strategic value-based care planning and the associated implementation of commercial and government value-based care programs.
  • Facilitates the integration of information across the care continuum to inform strategy and support execution of value-based delivery through the lens of clinical documentation and coding integrity.
  • Lead, develop, and identify key strategies for the review, improvement/accuracy of, and reporting of Hierarchical Condition Categories (HCCs), risk adjustment, the Risk Adjustment Factor (RAF) score, quality outcomes, and the overall integrity and completeness of the patient’s medical record.  
• Responsible for understanding clinical documentation through the lens of local and national quality and ranking methodologies, including but not limited to, U.S News and World Report, Vizient, Leapfrog, the CMS Star Rating, and payer contracts and implement key strategies to teach and deploy the team in the manner necessary to effect change. 
  • Lead, develop, and identify key strategies for the review, improvement/accuracy of, and reporting of Observed to Expected Mortality/Length of Stay/Cost Ratios, Case Mix Index (CMI), DRG denials, Mortalities, Patient Safety Indicators (PSI) and Hospital Acquired Conditions (HAC).
• Designs, plans, and leads the monthly Clinical Documentation Integrity executive committee.
• Evaluates designs, leads and implements NM integration activities.
• Collaborates with clinical documentation leadership to align work efforts to the extent possible throughout NM.
• Advances the standard of quality across NM through innovation, learning and shared deployment of best practices.
• Monitors internal and external trends and benchmarking data to identify priorities and implements strategies for improvement in the overall integrity of the patient’s medical record. 
• Maintains foundational knowledge of health policy and Medicare/other payers payment policy and supports NM leadership in understanding health policy implications on enterprise documentation and coding planning activities.
• Designs, leads and implements monitoring and surveillance of process and outcome metrics and develops, supports, and maintains a monthly reporting and communication process to key stakeholders. 
• Identifies, develops, and implements key strategies to leverage the electronic health record (EHR) and other tools to facilitate accurate representations of patient acuity, severity of illness, risk of mortality, medical necessity, and risk adjustment within the medical record. 
• Leads activities including project proposal, charter definition, budget development, resource allocation and management, information distribution and meeting facilitation.
• Provides proactive, clear, concise and timely communications regarding project status and overall performance reporting among team members, project sponsors and any external partners or customers; facilitate continuous exchange of ideas, information and project developments. 
• Evaluates, collaborates with and leads engagements with external vendors that support clinical documentation education, data analysis, and technology.
• Responsible for developing and maintaining productive and cordial relationships with clients and team members, including payer partners, serving as a link between multiple parties and entities; effectively manages project risks, issues and problems that arise within the project and recommend mitigation strategies, as needed, to achieve the desired results.

Qualifications

Required:

• Bachelor’s degree
• 8-10 years of healthcare experience
• Excellent communication and interpersonal skills.
• Proven skills in leadership, planning and quality.
• Project management, facilitation, and analytical skills
• Excellent judgment and quality assessment skills and a working knowledge of trends in health care management, staff issues and economics.

Preferred:

• Master’s degree in relevant field

Equal Opportunity

Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.