RN, Clinical Documentation Integrity Specialist

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 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 presenting clinical evidence objectively and supporting provider clarification without directing clinical conclusions Partner with physicians, nurse practitioners, and clinical teams through chart-side discussion, consultation, and structured education Participate in interdisciplinary team meetings and clinical workflows to surface documentation opportunities in real time 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 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 expose deficiencies, unsupported diagnoses, condition validation concerns, compliance risks, and systemic trends to CDI program leadership Contribute innovative ideas involving AI and perform other duties as assigned Requirements 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 Preferred Bilingual Spanish a plus Tuberculosis screening upon hire or proof of a negative screening within the last year Core Competencies Demonstrates expertise in clinical documentation integrity, risk adjustment, and HCC coding, with a strong ability to analyze and synthesize complex medical records. Proficient in engaging with clinical teams and providing education aligned with CMS documentation standards. Highest-signal resume keywords Active RN Or NP License Clinical Documentation Integrity ICD-10-CM Coding Principles Electronic Health Record Systems Risk Adjustment Analytics Tools Hard Skills Clinical Experience Documentation Improvement Chart Review Workload Management Analytical Thinking Clinical Judgment Soft Skills Strong Communication Skills Attention To Detail Problem-Solving Skills Certifications & Qualifications CRC CDEO CCDS-O CDIP Industry Keywords Medicare Advantage Value-Based Care Capitated Care Outpatient Care Ambulatory Care Tools & Technologies CDI Software Platforms Reporting Dashboards Documentation Tracking Systems #J-18808-Ljbffr Jobtailor