RN, Clinical Documentation Integrity Specialist

• 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
• 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 presenting clinical evidence objectively and supporting provider clarification without directing clinical conclusions
• Partner with physicians, nurse practitioners, and clinical teams through chart-side discussion, consultation, and structured education
• Participate in interdisciplinary team meetings and clinical workflows to surface documentation opportunities in real time
• 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
• 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 expose deficiencies, unsupported diagnoses, condition validation concerns, compliance risks, and systemic trends to CDI program leadership
• Contribute innovative ideas involving AI and perform other duties as assigned

• 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
• Familiarity with Medicare Advantage, PACE, capitated care, or other value-based care models
• 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
• Preferred Bilingual Spanish a plus
• Tuberculosis screening upon hire or proof of a negative screening within the last year

Demonstrates expertise in clinical documentation integrity, risk adjustment, and HCC coding, with a strong ability to analyze and synthesize complex medical records. Proficient in engaging with clinical teams and providing education aligned with CMS documentation standards.

• Active RN Or NP License
• Clinical Documentation Integrity
• ICD-10-CM Coding Principles
• Electronic Health Record Systems
• Risk Adjustment Analytics Tools

• Clinical Experience
• Documentation Improvement
• Chart Review Workload Management
• Analytical Thinking
• Clinical Judgment

• Strong Communication Skills
• Attention To Detail
• Problem-Solving Skills

• CRC
• CDEO
• CCDS-O
• CDIP

• Medicare Advantage
• Value-Based Care
• Capitated Care
• Outpatient Care
• Ambulatory Care

• CDI Software Platforms
• Reporting Dashboards
• Documentation Tracking Systems