The Supervisor, Clinical Documentation Improvement & Risk Adjustment is a working supervisor responsible for coordinating and supervising the day-to-day operations of the Risk Adjustment/Clinical Documentation Improvement RN team while actively participating in clinical documentation and medical record review activities.
The Supervisor sets daily priorities, assigns and coordinates work, monitors workflow and performance, provides clinical and operational guidance, and supports staff development to ensure timely, accurate, and consistent completion of work. In addition to supervisory responsibilities, the Supervisor conducts medical record reviews to support the complete and accurate capture of documented chronic conditions under HCC and other applicable risk adjustment models. The role reviews clinical information from EpicCare and available claims data, supports prospective and retrospective review activities, and helps ensure documentation and coding opportunities are clinically supported and consistent with established guidelines and standard work.
The Supervisor works collaboratively with Risk Adjustment leadership, clinicians, Coding, Analytics, and other operational partners to support quality, workflow consistency, provider education, and Optum Massachusetts risk adjustment initiatives.
Primary Responsibilities
Working Supervisor & Daily Operations
- Supervises and coordinates the day-to-day activities of the Risk Adjustment/CDI RN team
- Functions as a working supervisor, maintaining an active role in clinical documentation and medical record review activities while overseeing daily team operations
- Establishes daily priorities and assigns work to ensure timely completion of team responsibilities
- Monitors workloads and adjusts assignments based on operational priorities, patient volumes, upcoming appointments, and staffing needs
- Coordinates staffing and coverage to support continuity of daily operations
- Provides day-to-day clinical and operational guidance to team members
- Identifies and resolves operational issues using established processes, clinical expertise, and professional judgment
- Coordinates work activities with other supervisors, leaders, and operational partners
- Develops short-term plans to support department priorities and objectives
Clinical Documentation & Medical Record Review
- Performs prospective, concurrent, and retrospective medical record reviews as part of the team's established workflow
- Reviews clinical documentation within the electronic health record and available claims information to identify and validate chronic conditions relevant to applicable risk adjustment programs
- Evaluates documentation for clinical support and accuracy in accordance with established clinical, documentation, and coding guidelines
- Supports identification of potential documentation opportunities for patients with upcoming visits
- Reviews new patients for clinically supported conditions relevant to risk adjustment programs
- Applies knowledge of CMS risk adjustment principles, HCC models, ICD-10-CM coding, and established organizational guidelines when performing reviews
- Serves as a clinical resource for staff regarding medical record review and documentation questions
Quality Assurance
- Conducts quality assurance audits of completed medical record reviews and abstractions
- Monitors adherence to established clinical guidelines, documentation requirements, and standard work
- Provides timely and constructive feedback to staff based on audit findings
- Identifies trends and opportunities for clinical education, workflow improvement, and increased consistency
- Collaborates with leadership and appropriate clinical resources to clarify clinical guidelines and standardize team processes
- Supports development and implementation of quality improvement initiatives
Performance & Workflow Management
- Monitors team productivity, quality, throughput, and established performance metrics
- Reviews operational data to identify workflow barriers and opportunities for improved efficiency and effectiveness
- Promotes consistent application of workflows and standard work across the team
- Identifies opportunities to improve clinical documentation accuracy and appropriate identification of risk-adjustable conditions
- Escalates significant clinical, operational, compliance, or workflow concerns to appropriate leadership
- Participates in implementation and monitoring of new processes, tools, and risk adjustment initiatives
Staff Supervision & Development
- Participates in interviewing, selection, onboarding, orientation, and training of employees
- Plans, assigns, and directs daily work
- Provides ongoing coaching and clinical guidance
- Evaluates employee performance and provides regular feedback
- Identifies employee development and educational needs
- Addresses performance or workflow concerns in accordance with organizational policies
- Supports a collaborative work environment focused on quality, accountability, and continuous improvement
Collaboration & Provider Support
- Collaborates with clinicians, coding teams, Risk Adjustment leadership, Analytics, and other operational partners
- Supports clinician education related to clinical documentation and applicable risk adjustment programs
- Serves as a resource for clinical documentation and risk adjustment workflow questions
- Participates in development and implementation of processes supporting Optum Massachusetts risk adjustment objectives
- Supports communication between frontline staff, clinicians, operational teams, and leadership
Supervisory Responsibilities
- Directly supervises assigned Risk Adjustment/Clinical Documentation Improvement RN staff while maintaining hands-on responsibility for designated clinical and operational work
- Daily work assignment and prioritization
- Staff scheduling and operational coverage
- Productivity and quality monitoring
- Quality assurance and chart auditing
- Coaching and employee development
- Performance feedback and evaluations
- Training and onboarding
- Staff issue resolution
- Participation in interviewing and hiring
- Supporting adherence to policies, procedures, clinical guidelines, and standard work
Required Qualifications
- Undergraduate degree in Nursing or equivalent education and experience consistent with organizational requirements
- Current, unrestricted Registered Nurse (RN) license in the applicable state
- If CRC certification is not held at the time of hire, certification must be obtained within one year of employment
- 3+ years of clinical experience
- 3+ years of clinical experience working with chronic disease populations in an ambulatory and/or inpatient setting
Preferred Qualifications
- Professional coding certification, CRC through AAPC
- Experience across multiple specialties and disease states
- Experience with clinical documentation, risk adjustment, medical record review, HCC programs, clinical auditing, or coding
- Previous supervisory, team lead, or demonstrated leadership experience
Knowledge, Skills & Competencies
- Solid clinical knowledge of chronic disease populations
- Knowledge of clinical documentation integrity and risk adjustment principles
- Working knowledge of HCC models and applicable CMS requirements
- Working knowledge of ICD-10-CM coding principles
- Solid medical record review and clinical validation skills
- Ability to conduct quality audits and provide constructive feedback
- Solid analytical and problem-solving skills
- Ability to prioritize and coordinate the work of a clinical team while maintaining hands-on responsibilities
- Solid written and verbal communication skills
- Ability to coach and develop staff
- Ability to collaborate effectively with clinicians, coding, analytics, operations, and leadership
- Solid electronic health record navigation skills
- Proficiency with Microsoft Office applications, including Excel
Working Supervisor Role
This is a working supervisor position that combines direct day-to-day supervision of the RN CDI/Risk Adjustment team with active participation in medical record review, quality assurance, clinical documentation activities, and risk adjustment workflows.
The salary for this role will range from $72,800 - $130,000 annually based on full-time employment.