Registered Nurse - CDI Second Level Reviewer

University of Washington • Seattle, WA

11d • $120,000 - $165,600 • Remote

About The Position

UW Medical Center - Montlake has an outstanding opportunity for a Second Level Review Clinical Documentation Integrity Specialist (RN). WORK SCHEDULE Full-Time, Days Remote position POSITION HIGHLIGHTS Following established policies, procedures, and professional guidelines, the Second Level Review Clinical Documentation Integrity Specialist provides industry expertise on focused accounts that are set by the direction of CDP leadership to ensure high quality standards are met for risk adjustment, DRG accuracy, SOI and ROM. DEPARTMENT DESCRIPTION The Clinical Documentation Program review inpatient medical records to ensure provider documentation accurately reflects patient severity of illness (SOI), acuity of care needs, risk of mortality (ROM) and the quality of treatment provided. PRIMARY JOB RESPONSIBILITIES Reviews target DRGs, which is an evolving workflow. This review may focus on various elements including, but not limited to, CC/MCC capture rate and risk adjustment review. Ensures that pertinent patient conditions and treatments are documented such that appropriate reimbursement is received for the level of acuity and service rendered to all patients using a DRG based payer methodology. Coordinate CDI education for medical staff. Collaborate with CDI Physician Advisor. Participates in various projects and initiatives within the Clinical Documentation Program. Based on findings, department goals and initiatives, and industry expectation, the SLR CDIS will participate in the education and evaluation of the CDI team regarding findings and opportunities for documentation improvement in their record review. Collaborate with medical records coding staff, patient financial services (PFS) and compliance for Clinical Validation Denial appeals. Compliance with internal and external regulations and policies. Self-directed initiative for independent education with current evidenced-based practices.

Requirements

• Current WA RN License or compact RN license
• Minimum of 6 years of experience in an acute inpatient hospital setting as a registered nurse, with in-depth knowledge of medical and surgical care. ER or ICU experience preferred.
• Minimum of 5 years of experience in Clinical Documentation Integrity role; CDI leadership/educator/physician education experience preferred
• Risk adjustment experience required (Vizient and Elixhauser preferred)
• Denial/Appeal experience preferred
• Required current certification CCDS or CDIP.
• Coding certification preferred.

Nice To Haves

• ER or ICU experience preferred.
• CDI leadership/educator/physician education experience preferred
• Risk adjustment experience required (Vizient and Elixhauser preferred)
• Denial/Appeal experience preferred
• Coding certification preferred.

Responsibilities

• Reviews target DRGs, which is an evolving workflow.
• Ensures that pertinent patient conditions and treatments are documented such that appropriate reimbursement is received for the level of acuity and service rendered to all patients using a DRG based payer methodology.
• Coordinate CDI education for medical staff.
• Collaborate with CDI Physician Advisor.
• Participates in various projects and initiatives within the Clinical Documentation Program.
• Based on findings, department goals and initiatives, and industry expectation, the SLR CDIS will participate in the education and evaluation of the CDI team regarding findings and opportunities for documentation improvement in their record review.
• Collaborate with medical records coding staff, patient financial services (PFS) and compliance for Clinical Validation Denial appeals.
• Compliance with internal and external regulations and policies.
• Self-directed initiative for independent education with current evidenced-based practices.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 11-50 employees