Clinical Documentation Integrity Specialist - Registered Nurse

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.

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.
• 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.

Qualifications & Experience - Additional

• Tuberculosis Screening Policy: If 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 from providing information required in this policy, SCAN will initiate and engage in the interactive process to evaluate what, if any, reasonable accommodations may be available.