CDI Specialist - Mortality & Quality Reviews

CDI Specialist - Mortality & Quality Reviews

Summary/Objective The CDI Specialist – Mortality & Quality Reviews conducts second-level clinical chart reviews to evaluate and refine clinical documentation impacting patient mortality outcomes. This role performs in-depth clinical analysis to identify documentation gaps, ensure accurate risk adjustment, and collaborates with client leadership and internal teams to support quality and mortality initiatives.

• Perform comprehensive second-level clinical mortality reviews to evaluate documentation accuracy, severity of illness (SOI), and risk of mortality (ROM).
• Analyze clinical records to identify documentation opportunities, ambiguous clinical conditions, and missing diagnoses that directly influence mortality metrics.
• Partner professionally with client leadership, active clinical teams, and cross‑functional stakeholders.
• Participate in client-facing discussions, case reviews, and presentation of findings as required.
• Maintain clear, concise, and effective written and verbal communication across all internal team members and client personnel.
• Manage multiple review workflows and assigned priorities simultaneously while maintaining high precision, data integrity, and strict attention to detail.
• Analyze clinical records using risk‑adjustment models (e.g., APR-DRG, MS-DRG, Vizient) to ensure accurate Severity of Illness (SOI) and Risk of Mortality (ROM) representation.
• Track, evaluate, and analyze key mortality performance metrics, including Observed-to-Expected (O/E) Mortality ratios, query response rates, and agreement rates.
• Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance.

• Demonstrated ability to dissect complex medical records to isolate uncaptured secondary conditions, ambiguous principal diagnoses, or missing clinical indicators affecting risk adjustment.
• Proven track record of maintaining high accuracy in secondary reviews, data abstraction, and case log management.
• Self-directed ability to prioritize multiple review queues, balance efficiency with thoroughness, and meet tight reporting deadlines.
• Strict adherence to HIPAA, PHI standards, and compliant physician querying practices in alignment with AHIMA/ACDIS guidelines.
• Maintain courteous and professional working relationships with employees at all levels of the organization.

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While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; balance; stoop, kneel, crouch or crawl; and talk or hear. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception and the ability to adjust focus.

This is a full-time position. Each employee’s schedule must be between the hours of 6:00 AM PST to 9 PM PST, Monday through Friday with the specific schedule for each employee to be agreed upon by the employee’s manager and the employee, taking into account the needs of the client. This position occasionally requires long hours and weekend work.

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• Bachelor’s degree in a healthcare field (e.g., nursing, health information management) or an equivalent combination of education and experience.
• Minimum of 1 to 3 years of experience in Clinical Documentation Improvement (CDI), clinical quality, utilization management, case management, or nursing.
• Strong clinical acumen, disease process understanding, and critical thinking skills.
• Proficiency in Microsoft Excel for tracking review metrics, dynamic reporting, and data analysis.

• Healthcare related clinical credential preferred.
• 3 to 5 years of dedicated Clinical Documentation Improvement (CDI) experience with advanced clinical review capabilities.
• Demonstrated experience performing second-level clinical mortality reviews and clinical documentation…