CDI Quality Review RN

UT Southwestern Medical Center • Dallas, TX

15h • Remote

About The Position

The CDI Quality Review Nurse (QRN) will work under the direction of the Clinical Documentation Integrity ("CDI") Manager and conduct second-level reviews of targeted cases to identify and capture opportunities to improve the integrity of the medical record. The focus of the Quality Review Nurse will be on identifying and capturing methodology-specific risk variables (Vizient, HCC's, Elixhauser) on a post-discharge, pre-coding/billing basis, as well as identifying potential process improvements to capture the opportunities concurrently. The Quality Review Nurse will also validate that the record reflects the most appropriate principal diagnosis and diagnosis related group (DRG). The Quality Review Nurse will support the objective for accurate reflection of patient acuity, severity of illness, risk of mortality, and DRG assignment in compliance with industry rules and regulations.

Requirements

• Bachelor's Degree in Nursing
• 5 years patient care nursing experience in an acute care setting
• 3 years Clinical Document Integrity experience
• (RN) REGISTERED NURSE Upon Hire
• (CCDS) Cert Clinical Documentation Upon Hire or
• (CDIP) CERT DOCUMNTATN IMPROVMNT PRAC Upon Hire

Nice To Haves

• Master's Degree in Nursing
• 7 years patient care nursing experience in an acute care setting
• 5 years Clinical Document Integrity experience
• Experience working in a remote environment

Responsibilities

• Conduct post-discharge, pre-coding/billing reviews on targeted records identified for second-level review for opportunity to accurately capture methodology-specific risk variables (Vizient, HCC‿s, Elixhauser); present on admission (POA) status, patient admission source, avoidable patient safety indicators (PSI‿s), and DRG assignment in compliance with industry rules and regulations
• If a documentation opportunity is identified, place physician query and follow up for response
• If coding opportunity is identified, coordinate with Coding Team to review and address opportunity, as applicable
• Utilize methodology-specific risk calculators and guidance documents to understand if additional diagnoses and/or risk variables will impact the reported quality impact of a specific patient encounter
• Maintain a summary of opportunities identified through second-level review for feedback and education with the CDS Team, Providers, and Coding Team
• Identify and communicate any process improvement opportunities for front-end correction and education
• Periodically review the criteria established for cases triggering a second-level review and recommend updates or modifications to the criteria to maximize impact on quality scores
• Maintains an expert level of knowledge of CDI and Coding related guidelines and practices
• Other duties as assigned

Benefits

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100%25 coverage for preventive healthcare-no copay
• Paid Time Off, available day one
• Retirement Programs through the Teacher Retirement System of Texas (TRS)
• Paid Parental Leave Benefit
• Wellness programs
• Tuition Reimbursement
• Public Service Loan Forgiveness (PSLF) Qualified Employer

What This Job Offers

• Job Type: Full-time
• Career Level: Senior