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Description

Northwestern Medicine has an exciting opportunity for either a Nurse Practitioner or a Physician Assistant to work in our Outpatient Thoracic Surgery, Quality, Clinical Documentation department. 

This role is part of the Clinical Performance & Documentation Integrity Program, an integrated initiative between the Canning Thoracic Institute (NMG) and Clinical Documentation Improvement (NMHC). The program was established after a thoracic surgery pilot demonstrated that targeted, clinician-led documentation improvement meaningfully strengthened the alignment between coded data and clinical reality and produced measurable gains across multiple quality platforms - with no change in clinical practice, surgical technique, or patient selection. The improvement came entirely from ensuring the record reflected conditions that were already being clinically managed.

Schedule: M-F, 5x8s

• No nights, weekends, holidays, or on-call

The program is now scaling across the full thoracic surgery service lin. APPs are the operational linchpin of this model - clinically credentialed documentation experts who make documentation improvement part of the workflow rather than a retrospective coding correction.

• Maintain professional engagement & collaboration with the following:
• Active, valued participation in M&M and multidisciplinary review.
• Effective and reliable performance on the periodic occasions when clinical coverage is requested.
• Engage with respective CDI party (inpatient v. ambulatory)
• Engage with PB Coding, Inpatient coding, and Rev Cycles at NM
• Engage with Physician and APP Support Staff (PASS) Team
• Engage with NM & CTI Quality Committee
• Collaboration with relevant peers within DoS

Performance Expectations:

Performance in this role is evaluated against the quality and integrity of the documentation work product and the durability of the program the APP helps build. The expectations below are illustrative; specific objectives will be set annually with the Vice President, CTI, and the Division Chief.

• Documentation accuracy and integrity
• The medical record for assigned cases reflects the conditions clinically present, the complications encountered, and the procedures performed with the level of specificity supported by the chart.
• Concurrent and retrospective chart reviews are completed on the agreed cadence with consistent, reproducible methodology.
• Documentation queries follow AHIMA/ACDIS standards and are clinically grounded, non-leading, and well-substantiated.
• Sustained Present-on-Admission accuracy and clean PSI/HAC handling on assigned cohorts.
• Quality and benchmarking framework alignment
• STS, Vizient, US News, CMS Star Rating, Leapfrog, and HCC/RAF inputs are populated completely and consistently for assigned cohorts, with data definitions correctly applied.
• Risk-adjusted outcome metrics for the program reflect the true clinical complexity of the patient population - i.e., the chart, the coded data, and the reported metric tell a single, coherent story.
• Audit and second-review findings on assigned cases demonstrate documentation that is defensible against external scrutiny.

Program Development

• Onboarding curriculum delivered and used for every new program hire.
• EHR templates, SmartPhrases, and dot-phrases live in production for thoracic surgery, with documented adoption.
• Clinician-facing documentation reference materials (clinical indicator sheets, framework cheat sheets) maintained current.
• Demonstrated knowledge transfer: subsequent APPs reach independent competency within the agreed onboarding window.

Essential Functions: 

A. Comprehensive Mortality, Morbidity, and Severity Capture

The APP serves as the institute's accountable owner for the accurate capture of mortality and morbidity events, comorbid conditions, complications, and procedural detail across every quality, benchmarking, and regulatory reporting framework that measures the program. This includes - at minimum - the following platforms:

• ICD-10-CM and ICD-10-PCS
• Society of Thoracic Surgeons (STS) National Database
• Vizient Clinical Data Base / Resource Manager (CDB/RM)
• U.S. News & World Report ranking methodology
• MS-DRG / CC / MCC severity framework
• CPT coding for thoracic surgical procedures
• Elixhauser and Charlson comorbidity indices
• CMS Star Rating, Leapfrog Hospital Safety Grade, AHRQ PSIs, and CMS HACs
• CMS-HCC and Risk Adjustment Factor (RAF)

B. Independent Documentation Refinement After Physician Consultation

• Conduct concurrent and retrospective chart review for all assigned cases, identifying documentation gaps, inconsistencies, missing specificity, and opportunities for more accurate severity, complication, and comorbidity capture.
• Discuss findings with the responsible surgeon, intensivist, or consulting physician, presenting the clinical evidence (vital signs, labs, imaging, treatment, monitoring) that supports a more complete or more specific documentation.
• After clinical agreement is reached, independently enter, edit, or augment documentation in the medical record to reflect the agreed clinical picture - including progress notes, problem lists, discharge summaries, and procedural documentation - within the scope of APP authorship and consistent with Northwestern Medicine policy and Medical Staff Bylaws.
• Generate compliant, non-leading clinical documentation queries when direct consultation is not feasible, following AHIMA/ACDIS Practice Brief standards.
• Reconcile final coded data with the clinical record prior to bill drop where the workflow allows, ensuring that the coded MS-DRG, CC/MCC tier, and reportable complications match the documented clinical reality.

C. Application of Expert Clinical Judgment to Documentation

Clinical documentation frequently permits more than one defensible level of specificity. The same clinical scenario can - entirely within the bounds of compliant practice - be documented in ways that vary materially in how completely they convey patient acuity, complexity, and the work performed. Identifying the most accurate framing in those situations is a matter of expert clinical judgment, not a clerical exercise.

• Apply seasoned clinical judgment to recognize when the clinical evidence in the record supports more specific, more complete, or higher-acuity documentation than what has currently been written, and partner with the treating physician to clarify the record accordingly.
• Where documentation is clinically defensible at multiple levels of specificity, advocate - in collaboration with the treating physician - for the framing that most accurately and completely characterizes the patient's clinical reality, the conditions actively managed, and the resources required to deliver care.
• Use the interpretive latitude that legitimately exists in clinical documentation to ensure that the medical record fully reflects the work being done; never document, suggest, or query for a condition that is not clinically present, supported by the record, and actively managed.
• Maintain a clear, auditable rationale - anchored in clinical indicators in the chart - for every documentation refinement, so that any subsequent payer, regulatory, or internal review encounters a record that is both maximally accurate and fully defensible.

D. Education, Training, Onboarding, and Mentorship

• Develop and own the onboarding curriculum for all subsequent APPs, abstractors, CDI nurses, and analysts who join the program - including didactic content, case-based teaching files, shadowing protocols, competency checklists, and sign-off criteria.
• Serve as the primary clinical documentation educator for thoracic surgery faculty and trainees: deliver targeted education at section meetings, M&M conferences, and grand rounds; build and maintain EHR templates, SmartPhrases, and dot-phrases tailored to thoracic surgery workflow.
• Mentor and progressively transfer knowledge to incoming APPs as the program scales to additional service lines (cardiac surgery, neurosurgery, pulmonary medicine), so that each new APP reaches independent competency efficiently.
• Maintain a living internal reference - clinical indicator sheets, query templates, framework-specific documentation cheat sheets - that captures program knowledge in a form that survives staff turnover.
• Represent the program in vendor training (Vizient, STS, EHR), translating that content for the surgical and APP audience.

E. Performance Analytics and Continuous Improvement

• Partner with the CTI Quality & Benchmarking Analyst and the CDI Data Analyst to interpret performance data, identify documentation patterns associated with under-capture or inconsistency, and prioritize interventions.
• Co-develop and review the program's monthly and quarterly dashboards across the relevant frameworks, including STS composite inputs, Vizient O/E and case-mix metrics, US News methodology inputs, HCC/RAF capture, severity tier distribution, and audit and second-review findings.
• Lead root-cause review of any case where coded data, reported complication status, or risk-adjusted outcome appears inconsistent with the clinical course; close the loop with documenting clinicians and update training materials accordingly.
• Support audit response and second-level documentation review, providing the clinical-and-documentation translation that distinguishes a defensible case from one with documentation gaps.

F. Compliance and Professional Conduct

• Operate at all times within the ICD-10-CM/PCS Official Guidelines for Coding and Reporting, AHIMA/ACDIS query practice standards, the CMS Conditions of Participation, the Northwestern Medicine Medical Staff Bylaws, and the Northwestern Medicine corporate compliance program.
• Decline, escalate, or refer for second review any documentation request that appears to be unsupported by clinical evidence, and document the reasoning.
• Maintain absolute patient confidentiality consistent with HIPAA and Northwestern Medicine privacy policies.
• Complete all assigned compliance, privacy, and EHR-related training on schedule.

G. Clinical Coverage (As Needed)

Direct clinical care is not the primary function of this role. The APP maintains active clinical credentials and clinical capability so that documentation work remains anchored in real practice and so that the program retains clinical credibility within the surgical service.

• Maintain Northwestern Medicine clinical privileges appropriate to scope and remain current on clinical competencies, BLS, ACLS, and continuing education requirements.
• Provide periodic clinical coverage at the request of the Division Chief or designee - for example, planned absences, surge volume, or short-term gaps - without expectation of a fixed clinical schedule or assigned panel.
• Participate in multidisciplinary rounds, peri-operative huddles, morbidity and mortality (M&M) conferences, and quality review meetings as a clinical and documentation expert

Qualifications

Required:

• Master's degree from an accredited school/college of nursing OR master's degree from an accredited Physician Assistant Program  
• Current license as a Registered Nurse in the State of Illinois. Current license as an Advanced Practice Registered Nurse in the State of Illinois. Certification as an Advanced Practice Registered Nurse by a national certifying body as approved by the Illinois Department of Regulation APRN Board. Once licensed may apply for a controlled substance license and DEA number OR Master's degree from an accredited Physician Assistant Program/Current license as a Physician Assistant in the State of Illinois.  Once licensed may apply for a controlled substance license and DEA number
• Privileged and credentialed through the Medical Staff Office (MSO)
• Cardio-Pulmonary Resuscitation - BLS, issued by the American Heart Association 
• Minimum of three (3) years post-licensure APP experience

Preferred:

• Cardiothoracic surgery, cardiothoracic critical care, or surgical critical care experience

Equal Opportunity

Northwestern Medicine is an equal opportunity employer (disability, VETS) and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.

Background Check

Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check.  Results are evaluated on a case-by-case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.

Artificial Intelligence Disclosure

Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person. 

Benefits

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.

Sign-on Bonus Eligibility (if sign-on bonus offered for position): Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign on bonus. Exception: New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family. 

Required:

• Master's degree from an accredited school/college of nursing OR master's degree from an accredited Physician Assistant Program  
• Current license as a Registered Nurse in the State of Illinois. Current license as an Advanced Practice Registered Nurse in the State...