Clinical Documentation Improvement Manager - Remote

AcuteCare Health System LLC • Oceanport, NJ

3h • Remote

About The Position

Are you passionate about helping older adults live meaningful, independent lives at home with grace and dignity? BoldAge PACE is an all-inclusive program of care, personalized to meet the individual health and well-being needs of our participants. Our approach is simple: We listen to our participants and their caregivers to truly understand their needs and desires.

Clinical Documentation Improvement Manager

JOB SUMMARY

The Clinical Documentation Improvement Manager is a leadership role responsible for the design, implementation, oversight, and continuous improvement of a comprehensive clinical documentation integrity (CDI) and risk adjustment program within the PACE healthcare model.

This role ensures that clinical documentation accurately, completely, and compliantly reflects participant acuity, chronic conditions, and clinical complexity to support CMS risk adjustment, quality outcomes, regulatory compliance, and person‑centered care planning. The CDI Manager serves as the primary clinical authority for HCCs, ICD‑10‑CM documentation requirements, and CMS risk adjustment methodology, while also building and leading a team that may include certified risk adjustment coders and CDI professionals.

Requirements

• Active, unrestricted Registered Nurse (RN) license required.
• Minimum of five (5) years of clinical nursing experience, with at least three (3) years in clinical documentation improvement, risk adjustment, or HCC‑focused roles.
• Demonstrated expertise Medicare Advantage, Medicaid, and/or PACE full‑risk models.
• Strong working knowledge of ICD‑10‑CM coding guidelines and CMS risk adjustment methodologies.
• Experience educating and collaborating with provider‑level staff (MD/DO, NP, PA).
• Must have reliable transportation, a valid driver's license, and the minimum state required liability auto insurance.
• Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact.
• Employment with BoldAge PACE is contingent upon successful completion of post-offer pre-employment screening and verification processes

Nice To Haves

• Prior experience leading or mentoring CDI or coding teams strongly preferred.
• Professional certifications preferred (e.g., CCDS, CRC, CPC, CCS).
• Proficiency with EHR systems, data analysis, and clinical reporting tools.

Responsibilities

• Leads the organization’s CDI and risk adjustment strategy for Medicare Advantage, Medicaid, and PACE full‑risk populations.
• Serves as the clinical subject matter expert for Hierarchical Condition Categories (HCCs), MEAT/TREAT criteria, and CMS documentation standards.
• Reviews clinical documentation across settings (center‑based, home, inpatient, post‑acute) to identify documentation gaps, risks, and opportunities.
• Ensures diagnoses are clearly supported, evaluated, monitored, assessed, and treated within the medical record.
• Establishes standards and workflows for compliant documentation clarification and provider query processes.
• Performs targeted and high‑risk chart reviews to validate diagnosis accuracy and chronic condition management.
• Oversees the development and escalation of documentation queries in collaboration with coding staff.
• Ensures documentation improvement efforts remain clinically, compliant, and audit‑defensible.
• Ensures appropriate coding for all elements of clinical encounter documentation and other PACE related encounter documentation –example: ICD-10/HCC selection, Procedure and sub-procedure codes, procedure modifiers, Place of Service, etc.
• Develops and delivers structured education for MD/DOs, Nurse Practitioners, and Physician Assistants focused on documentation accuracy, specificity, and annual condition recapture.
• Provides real‑time, retrospective, and trend‑based feedback to providers in a collaborative, non‑punitive manner.
• Partners with Medical Directors and clinical leadership to reinforce accountability and documentation best practices.
• Serves as a trusted clinical advisor to providers, supporting improved documentation without disrupting care delivery.
• Builds, mentors, and leads a CDI and risk adjustment team (4–6 staff), including certified coders and clinical documentation professionals.
• Establishes role clarity, workflows, productivity expectations, and quality benchmarks for team members.
• Provides clinical oversight and coaching to ensure alignment between documentation, coding, and risk adjustment goals.
• Supports hiring, onboarding, competency validation, and performance management in partnership with leadership and HR.
• Leads internal monitoring, auditing, and quality assurance activities related to documentation and risk adjustment.
• Prepares for and supports external audits including CMS RADV, payer, and state reviews.
• Identifies compliance risks, develops corrective action plans, and monitors resolution.
• Ensures CDI and risk adjustment practices align with CMS regulations, organizational policies, and ethical standards.
• Collaborates with coding, quality, compliance, finance, and operational leaders to align documentation integrity with organizational performance goals.
• Engages with the Interdisciplinary Team to ensure documentation reflects the full clinical and functional complexity of participants.
• Develops and presents risk adjustment and documentation performance reports to leadership.
• Supports integration of risk adjustment principles into care planning, reassessment, and ongoing participant management.
• Designs scalable CDI and risk adjustment workflows to support organizational growth and maturity.
• Evaluates EHR tools, templates, and reporting capabilities to improve efficiency and accuracy.
• Maintains current knowledge of CMS guidance, ICD‑10‑CM updates, and evolving risk adjustment models.
• Recommends policy, workflow, and technology enhancements to strengthen documentation integrity.

Benefits

• Medical/Dental
• Generous Paid Time Off
• 401K with Match
• Life Insurance
• Tuition Reimbursement
• Flexible Spending Account
• Employee Assistance Program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 101-250 employees