VP, Clinical Integrity

Department: Clinical Intelligence – Management

Location: Remote

FLSA Status: Exempt

People Leader: Yes

Travel: Less than 5%

Accuity partners with hospitals and health systems through a technology-enabled, physician-led model that improves clinical documentation integrity, coding accuracy, reimbursement optimization, and quality outcomes.

The Vice President, Clinical Integrity is a senior physician executive responsible for establishing and advancing Accuity’s clinical integrity strategy, governance framework, and clinical risk and compliance standards. Reporting to the Chief Medical Officer/Chief Medical Information Officer, this role provides enterprise leadership for the clinical accuracy, defensibility, consistency, and responsible use of Clinical Intelligence capabilities.

The role also leads the Clinical Integrity escalation and disagreement function and provides consultative physician support to related cross-functional workflows.

The VP, Clinical Integrity sets standards, decision frameworks, and oversight practices that support clinically accurate and compliant outcomes across technology-enabled workflows, ensuring best practices and efficiency gains are realized. Key performance expectations include leading cross-functional efforts to reduce avoidable or recurrent internal and client disagreements by 50%, measured by both case count and dollar impact against agreed baselines; achieve 95% or higher compliance on applicable third-party and client audits;

achieve 80% or higher actualization of high-value, compliant changes; and develop and implement best practices for contingency-fee clients that support the actualization of compliant changes. These goals must be pursued without compromising clinical accuracy, coding compliance, or appropriate escalation. Baselines, time frames, attribution, and measurement methodologies will be established with executive leadership and the relevant functional owners.

This leader partners with Clinical Operations, Product, Analytics, Compliance, and client-facing teams to ensure clinical requirements are translated into scalable solutions, risks are appropriately managed, and performance remains aligned with clinical, regulatory, operational, and business expectations.

• Establish and maintain enterprise standards for clinical accuracy, integrity, defensibility, and evidence-based decision-making.
• Develop governance frameworks that define clinical review, validation, approval, escalation, and accountability requirements.
• Set standards for the appropriate interpretation and use of clinical documentation, including the management of ambiguity, attribution, timing, and uncertainty.
• Ensure Clinical Intelligence capabilities and outputs remain aligned with accepted clinical practices, organizational policies, and client expectations.
• Chair or lead governance forums that evaluate clinical priorities, risks, exceptions, and material decisions.
• Maintain clear documentation of governance decisions, standards, and approval authorities.

• Lead the Clinical Integrity escalation and disagreement team and establish consistent expectations for intake, triage, review, documentation, turnaround time, decision-making, and reporting.
• Support the remediation and rebuttal process for escalated clinical or coding disagreements between physician reviewers and Documentation Integrity Specialists (DIS), including cases elevated through their respective management teams.
• Provide consultative physician support in resolving disagreements between tower CDI staff and physician reviewers, including development or review of clinically and coding-defensible rebuttals; tower and operational leaders retain ownership of day-to-day workflow and implementation.
• Provide clinical subject-matter expertise and case-preparation support to the Denials and Appeals team for selected payer peer-to-peer reviews and Administrative Law Judge (ALJ) proceedings; the Denials and Appeals team retains program and workflow ownership.
• Partner with the clinical content librarian, Knowledge Management, CDI, Coding, and other subject-matter experts to support and help coordinate formal review and updating of clinical criteria at least every six months, and sooner when changes in evidence, regulation, policy, or client requirements warrant.
• Exercise delegated authority for routine…