CDI, Quality & Risk Manager

St. Tammany Parish Hospital•Madisonville, LA

1d•Hybrid

About The Position

The Clinical Documentation Integrity, Quality, and Risk Adjustment Manager (CDQR) provides strategic and operational leadership for clinical documentation programs that ensure accurate, complete, and compliant medical record documentation. This role supports quality reporting, severity of illness and risk of mortality (SOI/ROM), value‑based reimbursement, and risk‑adjusted outcomes through strong oversight of CDI/CDE operations, auditing, education, and performance improvement. Oversees CDI/CDE staff, conducts and validates documentation audits, and ensures compliance with regulatory and risk‑based reimbursement requirements. Using audit findings, second‑level reviews, and performance metrics, the role identifies documentation gaps and trends, drives continuous improvement initiatives, and maintains alignment with evolving regulatory standards. In close partnership with Health Information Management (HIM), coding, quality, and physician leadership, this position promotes consistent productivity, operational efficiency, and documentation excellence across the organization. Collaborates closely with physicians, advanced practice providers, residents, coding teams, and CDI/CDE advisors to enhance documentation quality and specificity. The role also leads risk adjustment initiatives to ensure documentation accurately reflects patient complexity and care provided, supports reimbursement and quality outcomes, and meets payer requirements. Additionally, the manager develops and delivers targeted education on documentation best practices, coding and reimbursement implications, and quality performance concepts, while serving as a key liaison across documentation, coding, quality, and compliance functions.

Requirements

Graduate of an accredited School of Nursing
5 years of clinical experience in an acute or ambulatory care setting
3-5 years of leading/managing a clinical documentation team
Current State Registered Nurse License
Excellent written, verbal, and interpersonal communication skills, with the ability to build professional relationships and effectively collaborate with physicians, nursing staff, administration, and interdisciplinary teams.
Demonstrated leadership and team‑building abilities, including experience supporting and engaging both remote or hybrid teams, with an initiative-taking approach to problem solving and continuous improvement.
Strong analytical and critical‑thinking skills, with the ability to interpret clinical documentation excellence (CDE/CDI) metrics, identify trends, and develop actionable recommendations.
In‑depth knowledge of clinical documentation requirements, ICD‑10‑CM coding guidelines, and risk‑adjustment methodologies, including familiarity with Medicare, Medicaid, and other risk‑based reimbursement programs.
Ability to maintain current knowledge of regulatory requirements, industry trends, and emerging risk‑adjustment and documentation programs, and to adapt processes accordingly.
Demonstrated financial acumen, including experience working within a budget and interpreting financial and operational data to support decision‑making.
Strong organizational, planning, and time‑management skills, with the ability to work independently, set priorities, and manage multiple initiatives with minimal supervision.
Exhibits exemplary professionalism and discretion, with the ability to maintain confidentiality and manage sensitive information appropriately.
Availability to be on-site for required meetings and organizational need.
Proficiency with Microsoft Office applications (Word, Excel, PowerPoint) and experience using clinical documentation and coding tools, including 3M software and encoder systems.
Demonstrated broad clinical knowledge and understanding of complex disease processes, with experience supporting documentation improvement in inpatient/outpatient settings.
Ability to work independently with minimum supervision, set priorities, meet deadlines, multi-task, and problem solve.
Collaborate and promote teamwork using strong interpersonal skills

Nice To Haves

Bachelor of Science degree in Nursing
Experience with Medicare risk adjustment, Hierarchical Condition Categories, coding, billing, quality measures and auditing
RN with Current Certified Clinical Documentation Specialist (CCDS) through Association for Clinical Document Improvement Specialists (ACDIS)
Vizient Risk-Adjustment methodology knowledge and experience

Responsibilities

Provides strategic and operational leadership for clinical documentation programs.
Supports quality reporting, severity of illness and risk of mortality (SOI/ROM), value‑based reimbursement, and risk‑adjusted outcomes.
Oversees CDI/CDE staff, conducts and validates documentation audits, and ensures compliance with regulatory and risk‑based reimbursement requirements.
Identifies documentation gaps and trends, drives continuous improvement initiatives, and maintains alignment with evolving regulatory standards.
Promotes consistent productivity, operational efficiency, and documentation excellence across the organization.
Collaborates closely with physicians, advanced practice providers, residents, coding teams, and CDI/CDE advisors to enhance documentation quality and specificity.
Leads risk adjustment initiatives to ensure documentation accurately reflects patient complexity and care provided, supports reimbursement and quality outcomes, and meets payer requirements.
Develops and delivers targeted education on documentation best practices, coding and reimbursement implications, and quality performance concepts.
Serves as a key liaison across documentation, coding, quality, and compliance functions.
Manages departmental operations, including productivity monitoring, audits, staff performance evaluation, and quality assurance activities.