Director-Clinical Documentation and Quality Utilization

Company Description

At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better healthcare, no matter where you work within the Northwestern Medicine system. At Northwestern Medicine, we pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, we take care of our employees. Ready to join our quest for better?

Job Description

The Director, Clinical Documentation and Quality Utilization reflects the mission, vision, and values of Northwestern Medicine (NM), adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

The Director is responsible for leading the system function of Clinical Documentation Responsible for managing relationships with key stakeholders at multiple business units to advance financial and quality outcomes for Northwestern Medicine (NM), as well as specific goals within local operating unit, Regional Medical Group (RMG) and/or Northwestern Medical Group (NMG).

The Director partners with other NM leaders to design, develop, plan and implement clinical documentation integrity efforts targeted at delivering innovative, timely, and accurate documentation across all entities. Functional areas of responsibility include monitoring internal and external performance and benchmarking data to identify priorities and implement strategies for improvement/accuracy. Responsible for identifying, developing, and implementing key strategies to leverage the electronic health record (EHR) and other tools to facilitate accurate representations of patient acuity, severity of illness, medical necessity, and risk adjustment within the medical record. Responsible for creating and monitoring a compliant oversight process related to coding/documentation/query best practices. Responsible for the design evaluation, maintenance and oversight of process and outcome metrics and the design, implementation, and maintenance of a reporting and communication process to key stakeholders.

Key to this role is the ability to evaluate, design, lead, and implement an aligned approach to clinical documentation integrity processes across NM as well as the ability to cultivate and maintain relationships with key stakeholders at all NM facilities. Requires extensive travel to support the business needs of Northwestern Medicine.

Reports to Vice President, Clinical Documentation

Responsibilities:

• Responsible for providing leadership to a portfolio of projects/ initiatives through active engagement of stakeholders and leading teams to outcomes which support the advancement of the NMHC Strategic Plan.
  • Key stakeholders include Business Unit and System Presidents and other members of the Senior Leadership Team, Value-Based Care Leadership, Care Coordination Leadership, Clinical Documentation Managers and Medical Directors, Quality Utilization Managers and Medical Directors, and the Physician and Advanced Practice Provider (APP) members.
  • Scope includes all functions which support documentation within the patient’s medical record. 
  • Scope includes all practitioners, clinicians and others participating in delivering or supporting patient care, including those privileged through the medical staff, trainees, students, employees, volunteers.
• Partner with Key Stakeholders (as above), as well as Clinical Quality, Coding, Corporate Integrity and Compliance, Social Work, Health Information Management (HIM), Patient Access, Analytics, EPIC IT, and other leaders to understand the national quality agenda, the annual system and regional key initiatives, the Inpatient Quality Composite goals, annual employee goals, and other business unit and system improvement initiatives to incorporate such goals, monitoring, and action plans into the annual Clinical Documentation Quality Integrity plan as appropriate. 
• Create and maintain annual quality plans
• Partner with the NMH Chief of Staff appointee and Chairperson of the NMH Quality Utilization Committee to lead the committee oversight of activities related to the review of all patients of all payer backgrounds with respect to the medical necessity of admissions to the hospital, the length of stay, and the hospital-based services rendered which include medications and biological treatments.
• Responsible for understanding the current and long-range strategic value-based care planning and the associated implementation of commercial and government value-based care programs.
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