Clinical Documentation Integrity Specialist - Registered Nurse
$71.7k - $105kSCAN Health Plan
- # Clinical Documentation Integrity Specialist - Registered NurseApplylocations: South Los Angeles: Greater Los Angelestime type: Full timeposted on: Posted 6 Days Agojob requisition id: JR2999myPlace Health is built around a simple but powerful belief: older adults deserve the support they need to live safely, independently, and with dignity in their own communities. As a PACE (Program of All Inclusive Care for the Elderly) organization backed by SCAN Group, myPlace Health brings together customized medical care, social activities, and daily support for participants and their families – all under one roof.Our centers are more than healthcare facilities. They are vibrant community hubs where participants are known by name, valued, and supported as whole people. Behind that experience is a dedicated, interdisciplinary team working together to coordinate care, remove barriers, and improve quality of life for some of the most medically and socially complex populations.For employees, myPlace Health offers the opportunity to do deeply meaningful work in a highly collaborative setting. Team members are encouraged to contribute innovative ideas, and grow alongside a mission that prioritizes compassion, respect, and impact. The result is a culture where people feel connected—to their colleagues, their participants, and the communities they serve.At myPlace Health, work is more than a job. It’s a shared commitment to honoring what matters most.The Clinical Documentation Integrity (CDI) Specialist supports accurate, complete, and clinically specific provider documentation across the myPlace Health participant population. This clinically credentialed role partners with providers, interdisciplinary care teams, and risk adjustment stakeholders to ensure documentation reflects each participant’s clinical complexity, disease burden, severity of illness, and care needs.Operating within the PACE model, the CDI Specialist conducts clinically supported chart reviews, identifies documentation opportunities, and collaborates with physicians, nurse practitioners, and care teams to support compliant CMS-HCC capture and sustainable documentation improvement.**RESPONSIBILITIES:*** Conduct prospective, concurrent, and retrospective reviews of medical records to identify documentation gaps, unsupported diagnoses, missed HCC opportunities, and clinically present conditions requiring provider assessment or clarification.* Apply clinical reasoning to synthesize information across EMR documentation, laboratory results, imaging reports, medications, specialist notes, and outside records to support accurate and clinically specific documentation.* Review longitudinal chart trends to identify disease progression, chronic condition indicators, and opportunities to improve documentation of participant complexity and severity of illness.* Formulate compliant verbal and written provider queries that present clinical evidence objectively and support provider clarification without directing clinical conclusions.* Partner directly with physicians, nurse practitioners, and clinical teams through chart-side discussion, consultation, and structured education to improve documentation quality and compliant CMS-HCC capture.* Participate in interdisciplinary team meetings and clinical workflows to surface documentation opportunities in real time and support accurate reflection of participant care needs.* Prioritize and manage daily chart review workflows based on risk stratification, HCC capture opportunities, documentation trends, and organizational priorities.* Track provider documentation patterns, query outcomes, capture rates, and review activity using CDI tracking tools and reporting systems to support program monitoring and audit readiness.* Develop and support provider-facing education, CDI resources, query templates, workflow guides, and performance reports aligned with CMS documentation standards and organizational policy.* Conduct documentation quality reviews and escalate documentation deficiencies, unsupported diagnoses, condition validation concerns, compliance risks, and systemic trends to CDI program leadership.* We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.* All other duties as assigned.**QUALIFICATIONS & EXPERIENCE:*** Active, unrestricted RN or NP license in the state of California.* Minimum of three years of clinical experience in an outpatient, primary care, ambulatory care, or comparable clinical setting.* Demonstrated ability to interpret, analyze, and synthesize clinical information across complex, multi-source medical records.* Foundational knowledge of ICD-10-CM coding principles and their relationship to clinical documentation requirements.* Strong written and verbal communication skills, with the ability to engage credibly and collaboratively with physicians, nurse practitioners, and clinical care teams.* Proficiency with electronic health record systems, digital workflows, and documentation or reporting tools.* Ability to work independently, manage a structured chart review workload, and prioritize effectively in a fast-paced clinical environment.* Strong attention to detail, analytical thinking, clinical judgment, and problem-solving skills.* Experience in clinical documentation integrity, risk adjustment, HCC coding, or documentation improvement, preferably in an outpatient, primary care, ambulatory care, or value-based care setting.* Familiarity with Medicare Advantage, PACE, capitated care, or other value-based care models.* CRC, CDEO, CCDS-O, CDIP, or comparable documentation/risk adjustment certification preferred; candidates without certification must demonstrate commitment to obtain certification within 12 months of hire.* Experience using CDI software platforms, risk adjustment analytics tools, reporting dashboards, or related documentation tracking systems.* Experience providing clinical provider education, including one-on-one coaching, chart-based feedback, and group education.**Tuberculosis Screening Policy**To ensure the health and safety of our members, if you are selected for this position, your job offer with SCAN will be contingent on providing proof of Tuberculosis screening upon hire or providing proof of a negative screening within the last year. If you have a disability/medical reason or sincerely held religious belief that prevents you to provide information required in this policy, SCAN will initiate and engage in the interactive process to evaluate what, if any, reasonable accommodations may be available.**What's in it for you?**Base salary range: $71,700 to $105,000 per yearAn annual employee bonus programMedical, Dental, Vision coverageGenerous paid-time-off (PTO)11 paid holidays per year, plus 1 additional floating holidayExcellent 401(k) Retirement Saving Plan with employer match.Robust employee recognition programRobust Wellness Program#LI-KF1
- J-18808-Ljbffr SCAN Health Plan
Vacancy posted 2 days ago
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