Clinical Documentation Improvement Manager - Remote

Join BoldAge PACE and Make a Difference!

Why work with us?

Competitive Compensation:

BE PART OF OUR MISSION!

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.

ESSESNTIAL DUTIES AND RESPONSIBILITIES:

Clinical Documentation Integrity & Risk Adjustment Leadership

• 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.

Documentation Review & Query Oversight

• 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.

Provider Education & Clinical Engagement

• 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.

Team Leadership & Program Development

• 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.

Compliance, Audits & Quality Assurance

• 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.

Collaboration, Reporting & IDT Integration

• 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.

Continuous Improvement & Program Growth

• 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.

Metrics for Success

• Improvement in HCC capture and recapture rates, including chronic condition accuracy and annual recapture compliance.
• Increased percentage of diagnoses meeting MEAT criteria.
• Reduction in unsupported, vague, or non‑specific diagnoses.
• Positive performance trends in internal and external audits.
• Improved provider documentation accuracy following education interventions.
• Successful recruitment, onboarding, and retention of CDI and risk adjustment staff.

EXPERIENCE AND EDUCATION 

• 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).
• 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.

PRE-EMPLOYMENT REQUIREMENTS:

• 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

BoldAge PACE provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. 

* Match begins after one year of employment