Group Clinical Documentation & Denial Prevention Specialist - Full time (HYBRID)

UHS • Chicago, IL

18d • Hybrid

About The Position

Are you a clinical detective with a passion for precision? We’re looking for a strategic leader to bridge the gap between high-quality patient care and accurate medical reporting. In this role, you won't just review charts; you’ll be the architect of a more resilient, compliant, and efficient healthcare system.
How You’ll Make an Impact:
Guardian of Accuracy: Perform daily deep-dives into medical records to ensure the severity of illness and intensity of services are captured with clinical integrity.
Denial Architect: Analyze clinical status and treatment plans to proactively resolve ambiguities, drastically reducing denials through advocacy and process improvement.
Clinical Educator: Transform complex compliance requirements into actionable knowledge by developing and leading documentation training programs for all medical staff.
Strategic Consultant: Partner with the Medical Records and Utilization Management committees, providing the data-driven insights and statistics needed to steer hospital-wide quality assurance.
Quality Advocate: Implement sophisticated workflows that ensure every patient’s story is told accurately, securing the resources they need for recovery.
What You Bring:
A keen clinical eye capable of synthesizing lab results, diagnostic data, and provider notes into a cohesive medical narrative.
The expertise to navigate Utilization Management standards and medical necessity requirements.
A collaborative spirit ready to mentor multidisciplinary teams on documentation best practices.
JOB SUMMARY: The Clinical Documentation & Denial Prevention Specialist responsibilities include:
Performing thorough daily review of medical records to ensure they accurately reflect the level of care provided and compliance with medical necessity documentation requirements. Analyzing the medical record regarding the clinical status of patient, current treatment plan and past medical history and seeking clarification of incomplete, unclear, and ambiguous documentation.
Developing and implementing plans for both formal and informal education of attending provider, nursing, social worker and other clinical staff. Providing education and training to staff on clinical documentation best practices and medical necessity criteria.
Collaborating with attending providers to ensure clinical information is accurately and comprehensively documented. Intervening with clinical and Medical Staff to ensure documentation supporting applicable diagnosis. Providing education to providers and other clinicians on compliant documentation practices to support medical necessity, severity, reimbursement and continuity of patient care.
Career with Hartgrove Behavioral Health System Offers....
A rewarding career improving the lives of youth and adults
Resources of a large health system (UHS, Inc.)
An engaged leadership team
A commitment to patient safety
Career advancement and mobility
Competitive compensation & benefits package and sign-on bonus
And much more!
For information about the benefits we offer, please visit UHS Benefits Service Center

Requirements

• BS in Nursing or Masters degree in Social Work or Psychology.
• Minimum three years of clinical experience a hospital setting.
• At least one year experience in Utilization Management or knowledge of Medicare, Medicaid and Managed Care preferred.
• LCPC, LCSW or RN preferred
• Possesses knowledge of utilization review, insurance and managed care procedures.
• Comprehensive understanding of medical necessity criteria (InterQual, MCG, CALOCUS, LOCUS, ASAM) for acute inpatient behavioral health.
• Knowledgeable in behavioral health managed care and clinical assessment skills to align patient acuity with level of care practice guidelines - Diagnostic and Statistical Manual of Mental Disorders (DSM-V).
• Knowledge of DSM, ICD-10 and clinical best practices for treatment for medical, mental health and chemical dependency diagnoses, across all age spans preferred.
• Effective oral and written communication skills.
• Current knowledge of regulating /accrediting agency guidelines.
• Basic knowledge of computer skills and statistical analysis desired.

Responsibilities

• Performing thorough daily review of medical records to ensure they accurately reflect the level of care provided and compliance with medical necessity documentation requirements.
• Analyzing the medical record regarding the clinical status of patient, current treatment plan and past medical history and seeking clarification of incomplete, unclear, and ambiguous documentation.
• Developing and implementing plans for both formal and informal education of attending provider, nursing, social worker and other clinical staff.
• Providing education and training to staff on clinical documentation best practices and medical necessity criteria.
• Collaborating with attending providers to ensure clinical information is accurately and comprehensively documented.
• Intervening with clinical and Medical Staff to ensure documentation supporting applicable diagnosis.
• Providing education to providers and other clinicians on compliant documentation practices to support medical necessity, severity, reimbursement and continuity of patient care.

Benefits

• A rewarding career improving the lives of youth and adults
• Resources of a large health system (UHS, Inc.)
• An engaged leadership team
• A commitment to patient safety
• Career advancement and mobility
• Competitive compensation & benefits package and sign-on bonus

What This Job Offers

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