Job Description
Clinical Document Improvement Specialist – Hybrid Opportunity
We are seeking a skilled and detail-oriented Clinical Document Improvement Specialist to join a high-performing CDI department. This full-time, hybrid position runs Monday through Friday, 8:00 AM to 4:30 PM PT. The Clinical Document Improvement Specialist will be responsible for conducting concurrent reviews, querying clinical staff, and supporting accurate clinical documentation to reflect severity of illness, risk of mortality, and quality metrics.
Job Responsibilities – Clinical Document Improvement Specialist
Perform concurrent reviews on inpatient admissions with a daily caseload of approximately 25 cases.
Ensure clinical documentation supports CC/MCC capture, SOI/ROM, and other organizational quality initiatives.
Meet or exceed minimum productivity targets (25 reviews/day, 25% query rate).
Communicate with physicians and clinical teams to clarify documentation through compliant queries.
Review cases spanning multiple service lines including general surgery, trauma, orthopedic, spinal fusion, and bedside procedures.
Collaborate with CDI team to identify trends and documentation improvement opportunities.
Maintain up-to-date knowledge of coding, DRG methodology, and quality reporting metrics.
Required Qualifications – Clinical Document Improvement Specialist
Minimum 3 years of experience as a Clinical Document Improvement Specialist.
Licensed Registered Nurse (RN) in any U.S. state or Foreign Medical Graduate (e.g., MD, MBBS, MBChB).
Certified Clinical Documentation Specialist (CCDS) credential.
Strong understanding of inpatient CDI practices and documentation standards.
Proficient in conducting concurrent reviews and generating compliant provider queries.
Comfortable working in a hybrid environment with onsite and remote responsibilities.
Preferred Qualifications
5 or more years of experience in Clinical Documentation Improvement.
DRG audit or reconciliation experience.
Familiarity with quality metrics such as SOI/ROM and mortality tracking.
Experience with multiple hospital sites or systems.
This is an excellent opportunity for an experienced Clinical Document Improvement Specialist who is passionate about quality care, accurate documentation, and collaborative provider engagement. The ideal Clinical Document Improvement Specialist will be results-driven, inquisitive, and committed to documentation excellence.
Clinical Documentation Specialist, CDI Nurse, Documentation Integrity Specialist, DRG Validation Specialist, Medical Documentation Reviewer, Concurrent Review Nurse, Clinical Quality Reviewer, Clinical Chart Auditor, Health Information Integrity Specialist, CDI Consultant
...abundant wildlife, and vibrant community activities. Enjoy the thrill of new experiences, from golfing at scenic clubs to exploring nature trails. Live, work, and thrive in a region that blends professional fulfillment with a rich cultural vibe!JOB DESCRIPTION &...
...practice specializing in immigration law. We provide comprehensive legal services to individuals and families navigating the complexities... ..., working alongside experienced attorneys and legal staff. The intern will assist with a variety of tasks, providing valuable support...
...Construction Estimator Heavy Civil (San Antonio, TX)$120,000 per year + Benefits + Truck Stipend A well-established and highly respected heavy civil construction company based in San Antonio, TX is seeking a skilled Construction Estimator to join our growing...
...Our client, a leader in the medical equipment industry, is seeking a Mechanical Assembler to join their team. As a Mechanical Assembler, you will be part of the production department supporting the assembly of complex medical equipment. The ideal candidate will have strong...
...HealthTrust Workforce Solutions is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Kirksville, Missouri. Job Description & Requirements ~ Specialty: Labor and Delivery ~ Discipline: RN ~ Start Date: 08/11/2025~ Duration: 13 weeks...