Remote Prior Authorization Rn Jobs in Summerville, SC

Job Description Summary

Under the direction of the MUSC System Executive Director of CDI, the Divisional CDI Manager provides strategic and operational oversight of division-based Clinical Documentation Improvement (CDI) program performance. This role is responsible for driving the accuracy and integrity of provider documentation within the medical record and improving performance across publicly reported and internal quality metrics. The CDI Manager leverages internal and external data sources to monitor key performance indicators, identify trends and opportunities, and implement targeted, data-driven strategies that enhance both process and outcome metrics.

Entity

Medical University Hospital Authority (MUHA)

Worker Type

Employee

Worker Sub-Type​

Regular

Cost Center

CC003639 FLO - Health Information Management (HIM) (FMC)

Pay Rate Type

Salary

Pay Grade

Health-34

Scheduled Weekly Hours

40

Work Shift

Job Description

Under the direction of the MUSC System Executive Director of CDI, the Divisional CDI Manager provides strategic and operational oversight of division-based Clinical Documentation Improvement (CDI) program performance. This role is responsible for driving the accuracy and integrity of provider documentation within the medical record and improving performance across publicly reported and internal quality metrics. The CDI Manager leverages internal and external data sources to monitor key performance indicators, identify trends and opportunities, and implement targeted, data-driven strategies that enhance both process and outcome metrics.

The CDI Manager collaborates closely with physician groups, advanced practice providers, Coding, and Quality partners to promote accurate capture of clinical documentation supporting DRG assignment, risk adjustment, and quality indicator performance. The role includes oversight and optimization of CDI workflows, including case prioritization, review processes, re-reviews, and query practices, ensuring efficient operations and appropriate identification of documentation opportunities. The CDI Manager also maintains ownership of CDI-related systems and work queues, supporting testing, content integrity, and system enhancements to improve operational effectiveness.

In addition, the CDI Manager is responsible for monitoring team productivity, query performance, and engagement metrics, and for providing structured, data-informed coaching and feedback to CDI specialists to support individual and team development. This includes conducting case reviews, identifying educational gaps, and leading performance improvement efforts to drive accountability and continuous improvement.

The CDI Manager oversees all aspects of team management, including hiring, onboarding, training, performance evaluation, and ongoing staff development. The role fosters a culture of collaboration, psychological safety, and continuous learning by coaching and empowering team members to achieve performance goals. Administrative responsibilities include managing staffing coverage, approving time and attendance, maintaining schedules, and addressing operational or technical needs to ensure uninterrupted team performance.

Education:
•    Master's degree in: 
o    Nursing, Healthcare Administration, Business Administration or Public Health
•    Current SC RN license (or equivalent clinical credential if broadening applicant pool)
Experience
•    Minimum 5 years of acute care clinical experience
•    Minimum 3 years of inpatient CDI experience
•    Minimum 2 years of leadership or supervisory experience

Technical Knowledge:
•    Working knowledge of: 
o    MS-DRG methodology
o    CC/MCC capture
o    (SOI/ROM)
o    Query compliance standards
o    Clinical validation principles
o    ICD-10-CM coding concepts

Certifications:
•    CCDS or CDIP certification
•    Required upon hire or obtained within 6 months

Preferred Qualifications:

Experience:
•    5+ years CDI experience
•    Multi-hospital or system-level CDI experience
•    Experience leading remote teams

Physician Engagement:
•    Experience developing, delivering physician education and experience partnering with:
o    Physician Advisors
o    CMOs
o    Service Line Leaders
o    Medical Staff Leadership

Data & Analytics:
•    Experience analyzing: 
o    Query intensity
o    Case mix index (CMI)
o    Mortality performance
o    PSI/HAC results
o    CDI productivity metrics
o    Physician response and agree rates

Leadership Competencies
•    Team management, Performance coaching, Provider communication, Data analysis and performance improvement, Change management

.

Additional Job Description

Education:
•    Master's degree in: 
o    Nursing, Healthcare Administration, Business Administration or Public Health
•    Current SC RN license (or equivalent clinical credential if broadening applicant pool)
Experience
•    Minimum 5 years of acute care clinical experience
•    Minimum 3 years of inpatient CDI experience
•    Minimum 2 years of leadership or supervisory experience

Physical Requirements

• Mobility & Posture

Standing: Continuous, Sitting: Continuous, Walking: Continuous, climbing stairs: Infrequent, working indoors: Continuous, working outdoors (temperature extremes): Infrequent, working from elevated areas: Frequent, working in confined/cramped spaces: Frequent, Kneeling: Infrequent, bending at the waist: Continuous, Twisting at the waist: Frequent, Squatting: Frequent

• Manual Dexterity & Strength

Pinching operations: Frequent, Gross motor use (fingers/hands): Continuous, Firm grasping (fingers/hands): Continuous, Fine manipulation (fingers/hands): Continuous, reaching overhead: Frequent, Reaching in all directions: Continuous, Repetitive motion (hands/wrists/elbows/shoulders): Continuous, Full use of both legs: Continuous, Balance & coordination (lower extremities): Frequent.

• Lifting & Force Requirements

Lift/carry 50 lbs. unassisted: Infrequent, Lift/lower 50 lbs. from floor to 36”: Infrequent, Lift up to 25 lbs. overhead: Infrequent, Exert up to 50 lbs. of force: Frequent

• Vision & Sensory

Maintain corrected vision 20/40 (one or both eyes): Continuous, Recognize objects (near/far): Continuous, Color discrimination: Continuous, Depth perception: Continuous, Peripheral vision: Continuous, Hearing acuity (with correction): Continuous, Tactile sensory function: Continuous, Gross motor with fine motor coordination: Continuous.

• Selected Positions:
  • Olfactory (smell) function: Continuous
  • Respirator use qualification: Continuous

• Work Environment & Conditions

Effective stress management: Continuous, Rotating shifts: Frequent, Overtime as required: Frequent, Latex-safe environment: Continuous.

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees