Clinical Documentation and Utilization Review Specialist (RN) - Population Health (saintfrancis)

Job Description

Schedule: Monday - Friday 8am to 5pm

Potential HYBRID position after 90 days!

Job Summary: The Clinical Documentation and Utilization Review Specialist (RN) facilitates accurate documentation and enhances patient care and healthcare outcomes through effective clinical documentation improvement and post-acute utilization review. This role creates resources to streamline the coding/documentation process during patient encounters.

Minimum Education: Has completed the basic professional curricula of a school of nursing as approved and verified by a state board of nursing, and holds or is entitled to hold a diploma or degree therefrom.

Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Certified Clinical Documentation Specialist (CCDS), Certified Document Improvement Practitioner (CDIP), or Certified Document Expert Outpatient (CDEO), preferred.

Work Experience: Minimum 5 years of adult acute care experience in med/surg, critical care, emergency room or PACU. 2 years of CDI outpatient coding/auditing experience, preferred.

Knowledge, Skills and Abilities: Strong understanding of risk adjustment methodologies and clinical documentation standards. Working knowledge of utilization review and post-acute utilization management. Excellent analytical skills with attention to detail. Strong communication and collaboration skills. Excellent prioritization and time management skills. Basic computer proficiency within Microsoft 365. Working knowledge of healthcare software tools for analytics and patient flow.

Essential Functions and Responsibilities: Reviews and analyzes medical records for overall accuracy and completeness of clinical documentation to ensure it accurately reflects the diagnoses, co-morbidities, severity of illness, and care provided. Creates resources to streamline the coding/documentation improvement process during patient encounters. Recognizes opportunities for documentation improvement, formulates clinically credible documentation clarifications, and facilitates correction of documentation deficiencies through communication and interaction with providers, coding specialists, and ancillary staff. Demonstrates and applies knowledge of documentation requirements and guidelines in accordance with International Classification of Diseases, Tenth Revision (ICD-10-CM) official guidelines for Coding and Reporting, and of published query guideline and practice expectations for compliance. Develops and implements plans for education of providers and ancillary staff on correct documentation and coding practices. Reviews medical records and treatment plans in post-acute settings to evaluate the appropriateness and efficiency of care. Participates in interdisciplinary workgroups to communicate review findings, facilitates effective coordination of care, ensures compliance with regulatory standards, and promotes best practices in resource utilization.

Decision Making: Independent judgement in making decisions involving non-routine problems under general supervision.

Working Relationship: Coordinates activities of others (does not supervise). Leads others in same work performed (does not supervise). Works with internal and/or external customers via telephone or face to face interaction. Works with other healthcare professionals and staff.

Special Job Dimensions: None.

Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.

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