Blue Zones Health

Description:

OUR PHILOSOPHY 

At Blue Zones Health, complete clinical information is foundational to good care. What we know about a member lives across PCP records, specialist encounters, hospitalizations, claims, HIEs, health plans, and prior encounters. Bringing that information together gives providers and care teams the opportunity to recognize needs earlier. 

Clinical Documentation & Intelligence exists to answer three questions: What do we know about this member? What may we be missing? What should the care team be paying attention to? Answering them well means providers enter every encounter with a more complete picture of the member, and the resulting medical record accurately reflects the conditions evaluated and managed. 

This capability is part of a broader clinical learning system. Clinical Documentation & Intelligence surfaces the picture before the encounter. Providers assess and document the member's condition. Coding translates documented care into coded clinical information. Clinical Management uses clinical and utilization patterns to strengthen pathways and identify earlier intervention. Well-Being Services and care teams activate the lifestyle, care management, and community support members need. Together, the system continually becomes better at understanding members and supporting healthier outcomes. 

POSITION SUMMARY 

The Director of Clinical Documentation & Intelligence is responsible for ensuring that Blue Zones Health and its providers have the most accurate, complete, and clinically meaningful picture of every member. The role sits at the intersection of clinical care, clinical intelligence, documentation integrity, coding operations, provider education, Clinical Management, and Well-Being Services. 

The Director leads Blue Zones Health's approach to pre-visit clinical intelligence, suspect-condition identification, clinical documentation improvement, and provider education — transforming fragmented health information into actionable clinical insight. The Director also leads the Coding Manager and coding team, joining coding operations with pre-visit intelligence and documentation improvement under a single accountable function. 

Working closely with Medical Directors, the Director of Clinical Management, Clinical Operations, Well-Being Services, PCPs, and Product, this role helps ensure providers enter every encounter with the clearest possible understanding of the member in front of them. 

KEY RESPONSIBILITIES 

1.  Clinical Documentation & Intelligence Leadership 

• Lead Blue Zones Health's clinical documentation and clinical intelligence strategy, setting standards and workflows for accurate, complete, and clinically meaningful information across participating providers and clinical programs 
• Lead the Coding Manager and coding team, bringing coding operations together with pre-visit intelligence and documentation improvement under one accountable function 
• Build a clinical intelligence capability that gives providers a more comprehensive understanding of member health and supports better clinical decision-making 
• Partner with Medical Directors and clinical leadership to ensure documentation practices reflect clinical evidence, regulatory requirements, and appropriate standards of care 
• Serve as the clinical bridge among providers, Coding, Clinical Management, Clinical Operations, and Well-Being Services 

2.  Pre-Visit Planning & Clinical Intelligence 

• Lead the clinical strategy and design of pre-visit planning, bringing together relevant information from claims, hospital records, HIE data, specialist documentation, prior PCP records, and health plan data 
• Ensure providers receive concise, relevant, and actionable information before the encounter, including emerging risks, changes in member health, and potential unmet needs 
• Develop methodologies for prioritizing members and encounters that need deeper clinical review 
• Partner with technology teams to automate and scale pre-visit planning, continuously improving its usefulness based on provider feedback, clinical outcomes, Coding findings, and Clinical Management insights 

3.  Suspect Condition & Clinical Risk Identification 

• Lead Blue Zones Health's approach to clinically appropriate suspect-condition identification, including standards for surfacing conditions that may warrant provider evaluation, reassessment, or clarification 
• Ensure potential conditions are presented for clinical evaluation — never assumed, diagnosed, or automatically coded — and that workflows comply with CMS, health plan, and applicable regulatory requirements 
• Monitor whether suspect conditions are evaluated during encounters, and analyze missed opportunities to improve pre-visit planning and provider education 
• Identify emerging clinical patterns that may warrant review by Clinical Management 

4.  Provider Documentation Education & Enablement 

• Lead provider education on documentation integrity, diagnosis specificity, condition assessment, and documentation requirements, translating complex coding and regulatory requirements into practical clinical guidance 
• Develop education, tools, and feedback mechanisms that help providers see how complete documentation supports continuity of care, population health, and clinical decision-making 
• Identify recurring provider documentation gaps and deliver targeted education through onboarding, ongoing development, and performance improvement 
• Establish the function as a trusted clinical resource and partner to providers 

5.  Clinical Management Partnership 

• Partner with the Director of Clinical Management to ensure clinical intelligence and pre-visit planning supply the information needed for risk identification, clinical pathways, and earlier intervention 
• Incorporate clinical-management and utilization patterns into clinical intelligence workflows, surfacing emerging findings that may warrant Clinical Management review 
• Support development of clinical triggers by providing reliable clinical information, and use Clinical Management findings to continuously improve pre-visit planning and provider education 
• Maintain clear separation between clinical documentation activities and individual clinical decision-making 

6.  Well-Being Services Integration 

• Partner with Well-Being Services leadership to identify clinical information that points to opportunities for lifestyle support, care management, community resources, or other member-facing interventions 
• Establish information flows between Clinical Documentation & Intelligence and the broader WBS care model so clinically relevant findings contribute to earlier member engagement 
• Support the use of clinical intelligence to advance prevention, coordinated care, and improved chronic disease management through lifestyle-informed care 
• Create closed-loop learning between member outcomes and future clinical intelligence strategy 

7.  Coding Operations Leadership 

• Lead coding operations through the Coding Manager, including coding quality, coding audits, production standards, and team performance 
• Create a continuous feedback loop between pre-visit clinical intelligence and post-visit coding review 
• Use post-visit findings, audits, and recurring documentation patterns to improve pre-visit planning, provider education, documentation standards, and clinical workflows 
• Measure whether pre-visit interventions reduce preventable post-visit documentation deficiencies 
• Ensure coding determinations remain governed by the medical record and applicable coding standards, consistent with CMS, health plan, and regulatory requirements 

8.  Clinical Data & Continuous Improvement 

• Analyze documentation, diagnosis, coding, clinical, and utilization data to identify recurring gaps, emerging patterns, and opportunities for earlier intervention 
• Measure the effectiveness of pre-visit planning, suspect-condition identification, and provider education, and build reporting that shows the function's impact 
• Partner with Clinical Management to determine whether emerging patterns warrant pathway refinement, and recommend workflow, technology, or process improvements 
• Give leadership actionable insight into documentation completeness, provider adoption, clinical risk identification, and improvement opportunities 

Budgeted Compensation: $155,000-$170,000

Requirements:

REQUIRED QUALIFICATIONS

• Strong clinical background with demonstrated ability to interpret clinical records, diagnoses, treatment plans, and longitudinal member information 
• Significant experience in clinical documentation integrity, clinical informatics/intelligence, risk adjustment, population health, clinical operations, or a related field 
• Demonstrated understanding of ICD-10-CM coding, CMS risk-adjustment principles, documentation requirements, and suspect-condition workflows 
• Experience working directly with physicians and providing clinical documentation education 
• Strong understanding of chronic disease, clinical risk identification, comprehensive patient assessment, and value-based care 
• Demonstrated ability to translate complex clinical information into practical, actionable guidance for providers 
• Experience designing or improving clinical workflows 
• Strong analytical, communication, physician-engagement, and cross-functional leadership skills 

PREFERRED QUALIFICATIONS 

• Physician, Physician Assistant, Nurse Practitioner, Registered Nurse, or other clinically trained professional 
• Internationally trained physicians with substantial clinical experience who are not currently practicing in the United States may be considered where appropriate for the role 
• CCDS, CDIP, CRC, or related documentation/risk-adjustment credential 
• Experience in Medicare Advantage, value-based care, risk-bearing medical groups, IPAs, or population health 
• Experience with lifestyle medicine, preventive care, or whole-person care models 
• Experience developing technology-enabled pre-visit planning, clinical intelligence, or population-health workflows 
• Experience partnering with Product or technology teams to operationalize clinical information at scale