RN Documentation Improvement Specialist Job at Advocate Health Care (Kings Mountain)

RN Documentation Improvement Specialist

Location

United States , Kings Mountain

Salary:

38.20 - 57.30 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Registered Nurse applicable state Licensure required
Bachelor's Degree Required
Appropriate professional certification required within 3 years of hire date per department protocol
5 years of related nursing experience preferred
Clinical experience within the assigned population
Extensive knowledge of disease processes and clinical outcomes
Case Management experience or background helpful
Strong financial and analytical skills preferred
Word, Outlook, Excel experience preferred

Job Responsibility

Reviews selected populations of inpatient medical records to identify the principal and/or secondary diagnoses
Appropriately assigns the MS-DRG that most accurately reflects the severity of illness of the patient based upon the clinical evidence documented at the time of the record review
Demonstrates knowledge and understanding of severity based DRG systems
All Patient Refined and Medicare Severity (AP-DRG) and Medical Severity Diagnostic Related Group System (MS-DRG)
Demonstrates the ability to utilize the licensed software tool to perform and record daily medical record reviews
Interacts with the physician and/or other designated members of the healthcare team to ensure that vague or incomplete documentation is clarified within the medical record in a timely manner
Works with other departments such as coding, corporate compliance, quality, and finance to support Corporate Goals
Participates in the ongoing education of physicians, nurse practitioners, physician assistants and other healthcare team members to identify medical record documentation improvement opportunities employing conflict resolution skills as necessary
Utilizes critical thinking skills based upon extensive knowledge of disease processes and clinical outcomes to identify the need for further clarification of physician documentation within the medical record
Ensures that all written requests to physicians for additional documentation support Corporate Compliance policies

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Clinical Documentation Specialist RN

Improves the overall quality and completeness of clinical documentation by perfo...

Location

United States

Salary:

38.20 - 57.30 USD / Hour

Advocate Aurora Health

Expiration Date

Until further notice

Requirements

Graduate from an accredited school of nursing
BSN
5 years relevant clinical experience
Current nursing license in the State of Illinois
Ability to prioritize work
Excellent communication skills
Good problem solving skills
Critical thinking skills
Basic Computer skills
Effective problem-solver with good interpersonal communication skills, verbal and written

Job Responsibility

Improves the overall quality and completeness of clinical documentation by performing chart reviews using clinical documentation guidelines based on accepted standards, evidenced based practice, and current regulatory requirements
Communicates with appropriate healthcare team members to ensure accurate and complete documentation is in the medical record
Conducts follow-up reviews of clinical documentation to ensure points of clarification and agreed upon documentation have been recorded in the patient’s chart
Identifies the most appropriate principal diagnosis and complications including date to accurately reflect clinical acuity and risk of mortality in compliance with government regulations
Reviews clinical issues with coding staff to assign a working DRG, follows up with physicians if appropriate
Provide daily clinical evaluation of the medical record including physician and clinical documentation, lab results, diagnostic information and treatment plan
Confers with physicians, face to face or via clinical documentation inquiry forms, regarding missing, unclear or conflicting medical record documentation to clarify the information, obtain needed documentation, present opportunities, and educate for appropriate identification of severity of illness
Responsible for the day-to-day evaluation of documentation by the Medical Staff and healthcare team in accordance with the hospital’s designated clinical documentation policies and procedures
Gather and analyze information pertinent to documentation findings and outcomes
Educates all internal customers on clinical documentation opportunities, coding and reimbursement issues, as well as performance improvement strategies

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance

Fulltime

Clinical Documentation Specialist-RN

This role will facilitate the modifications of clinical documentation through ex...

Location

United States , Chicago

Salary:

38.20 - 57.30 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Graduate from an accredited school of nursing
BSN
5 years relevant clinical experience (For associates in process level 25013 5 years relevant pediatric clinical experience)
Clinical documentation improvement experience preferred
Ability to prioritize work
Excellent communication skills
Good problem solving skills
Critical thinking skills
Basic Computer skills
Effective problem~solver with good interpersonal communication skills verbal and written

Job Responsibility

Facilitate the modifications of clinical documentation through extensive initial and concurrent interaction with physicians and other members of the healthcare team to support appropriate documentation of the clinical severity and risk of mortality is captured for the level of services rendered to select inpatients populations
Supports timely accurate and complete documentation of clinical information used for measuring and reporting physician and hospital outcomes and provides education to all members of the health care team on an ongoing basis
Improves the overall quality and completeness of clinical documentation by performing chart reviews using clinical documentation guidelines based on accepted standards evidenced based practice and current regulatory requirements
Educates all internal customers on clinical documentation opportunities

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Appeals and Grievances Nurse Specialist RN II

The Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provi...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
At least 5 years of experience in Clinical RN
At least 2 years in Medicare/ Medicaid in a managed care/ health plan environment
Excellent interpersonal and communication skills
Computer literacy and adaptability to computer learning
Time management and priority setting skills
Must be organized and a team player
Able to work effectively with various internal departments/service areas, L.A. Care's plan partners, participating provider groups, and other external agencies
Good working knowledge of regulatory requirements/standards
Registered Nurse (RN) - Active, current and unrestricted California License

Job Responsibility

Conducts intake/triage and appropriate classification of Clinical A&G, and Pharmacy requests and makes accurate judgment on appeal, grievance, Provider Claim Disputes, medical records or other issues and follows procedures on how to handle each type of request and route to the appropriate area within the department
Investigation, and resolution of clinical member complaints (grievances/appeals) utilizing all regulatory requirements
Investigation, and resolution of clinical Provider Complaints/ Provider Data Resolution (PDR) (grievances/appeals) utilizing regulatory and internal guidelines and Service Level Agreement (SLA)
Identification of Expedited Cases and resolution within 72 hours
Works with the external providers and Participating Physician Group's (PPG) representatives to obtain relevant medical records and communication documentation
Prepares resolved complaint files for Centers for Medicare and Medicaid Services (CMS), DMHC, and external review organization (QIO or IRE)
Process the case thru to effectuation and final case documentation in the A&G system of record
Investigation and preparation of State Fair Hearing cases as assigned
Prepares resolved complaint files for CMS external review organization - Quality Improvement Organization (QIO) or Independent Review Entity (IRE)
Conducts reviews and presents to physicians, provider disputes which would be based on medical necessity reviews

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Managed Long Term Services And Supports Nurse Specialist Rn Ii

The Managed Long-Term Services and Supports (MLTSS) Nurse Specialist RN II appli...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
At least 3 years of clinical nursing experience in direct patient care, such as ambulatory care, home care, palliative care, hospice care OR experience in Utilization Review or Care Management will be considered in lieu of direct patient care that may include at least 2 years of relevant Licensed Vocational Nurse (LVN) experience in a UM or CM capacity substituted for 1 year of RN experience
Clinical experience working with individuals with chronic illnesses, comorbidities, and/or disabilities in a UM/CM environment
Excellent verbal and written communication skills
with effective charting practices
Excellent organizational, time-management and priority-setting skills
Strong clinical skills with a knowledge of care needs for elderly, disabled, and/or frail populations and has applied knowledge of End-of-Life care
Customer Service Skills: Provision of excellent customer service required due to frequent communication with providers, members and interdisciplinary team
Technical Skills: Must be computer literate and proficient in Microsoft Office (Outlook, Word, Excel, PowerPoint, Teams)
Ability to effectively utilize computer and appropriate software and interacts as needed with L.A. Care Information System

Job Responsibility

Responsible for performing assessments and clinical review of medical records to determine appropriate care including physical health, behavioral health, and social determinants of health needs for members referred to
MLTSS administered programs
Responsible for UM authorization functions for services requiring prior authorizations in a timely manner with adherence to regulatory requirements
Identify and address gaps in care or overutilization, including overlapping services
Engages with members by conducting telephonic nursing follow up and care coordination when necessary, including transitions of care for Long Term Care (LTC) and ICF/DD populations
Provides direction to non-clinicians who assist members with accessing services and arranges for all services required while coordinating with the health care team to eliminate duplication of services
Interfaces with Medical Directors, social workers, and interdisciplinary care team (ICT)
Participates in ICT meetings and makes recommendations for MLTSS and other programs
Establishes relationships with referral sources and community resources, such as external providers and care coordinators, while maintaining strict member confidentiality and complying with all Health Insurance Portability and Accountability Act (HIPAA) requirements
Performs oversight and monitoring of provider performance for adherence to regulatory standards and contractual agreements

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Utilization Management Nurse Specialist RN II

The Utilization Management Nurse Specialist RN II facilitates, coordinates, and ...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
At least 5 years of varied RN clinical experience in an acute hospital setting
At least 2 years of Utilization Management/Case Management experience in a hospital or HMO setting
Registered Nurse (RN) - Active, current and unrestricted California License
Must be computer literate, with expertise in Outlook, Word, Excel, PowerPoint
Provision of excellent customer service
Excellent time management and priority-setting skills
Maintains strict member confidentiality and complies with all HIPAA requirements
Strong verbal and written communication skills

Job Responsibility

Facilitates, coordinates, and approves medically necessary referrals that meet established criteria
Assures timely and accurate determination and notification of referrals and reconsiderations based on the referral determination status
Generates approval, modification and denial communications, to include member and provider notification of referral determination
Actively monitors for admissions in any inpatient setting
Performs telephonic and/or onsite admission and concurrent review, and collaborates with onsite staff, physicians, providers, member/family interaction to develop and implement a successful discharge plan
Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, post-service and retrospective claims medical review
Monitors and oversees the collection and transfer of data (medical records) and referral requests by Providers
Acts as a department resource for medical service requests /referral management and processes
Receives incoming calls from providers, professionally handles complex calls, researches to identify timely and accurate resolution steps
Follows up with caller to provide response or resolution steps

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Clinical Documentation Specialist

We’re seeking a detail-oriented and collaborative Clinical Documentation Special...

Location

United States , Concord

Salary:

49.00 - 56.00 USD / Hour

Emerson Hospital

Expiration Date

Until further notice

Requirements

Bachelor of Science in Nursing (BSN) or Bachelor of Science in Biology or a related healthcare clinical program (e.g., Medical Records/Health Information Management)
3–5 years of acute care or equivalent clinical experience, or 3+ years of inpatient coding experience
Current Massachusetts Registered Nurse (RN) license and/or AHIMA coding certification (e.g., CCS, RHIT, RHIA) required
Ability to work independently and manage responsibilities with minimal supervision
Strong verbal and written communication skills
Proven ability to build effective working relationships with a wide range of healthcare providers
Team-oriented mindset with strong collaboration and information-sharing skills
Critical thinking and problem-solving abilities in complex clinical scenarios
Strong organizational skills with the ability to stay focused despite frequent interruptions
Proficiency with computer systems and ability to quickly learn new software applications

Job Responsibility

Review medical records to ensure accurate, complete, and compliant clinical documentation
Collaborate with physicians and care teams to clarify and improve documentation quality
Apply clinical and coding knowledge to support accurate code assignment and reimbursement
Facilitate documentation improvement initiatives in both concurrent and retrospective reviews
Educate providers and care teams on CMS regulations, documentation standards, and best practices
Partner with coding professionals to ensure alignment between documentation and coding outcomes
Support quality, compliance, and continuous improvement initiatives across the organization

What we offer

Competitive compensation and comprehensive benefits

Fulltime

Clinical Informatics Specialist RN

The Clinical Informatics Specialist RN is a clinical professional who is under t...

Location

United States , Augusta

Salary:

Not provided

Wellstar Health System

Expiration Date

Until further notice

Requirements

Associates and/or equivalent Required
Bachelors of Science in a Health related field - Preferred
Reg Nurse (Single State) or RN - Multi-state Compact
Basic Life Support or BLS - Instructor
Minimum 3 years of experience in clinical practice at the bedside and/or information systems related activities Required
experience with a combination of clinical practice and information system implementations. Preferred
Ability to read, write and speak the English language.
Strong customer service skills.
Proficient in the use of Internet browsers and Microsoft Office products.
Excellent verbal and written communication skills.

Job Responsibility

Provide clinical informatics services to individuals, physicians, departments and agencies that are a part of WellStar Health System.
Participates in the assessment of needs pertaining to clinical information systems, including hardware, software, staff development and management support.
Provides content expertise that supports care area teams.
In collaboration with clinical leaders, this role is responsible for the design, development and implementation of the clinical informatics plan.
Provides leadership and change management methodologies to advance the clinical team utilization of informatics.
Oversees end user optimization and efficiency, embeds evidence based, and analytics model to ensure patient outcomes and improve clinical performance.
Works with members of the information technology departments, providers, super-users, clinical departments and other WHS personnel to accomplish strategic goals.
Analyze clinical workflows and be able to promote process changes to support the proficient use of the system.
Assess information and knowledge needs of health care professionals and patients.
Characterize, evaluate, and refine clinical processes.

Fulltime

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RN Documentation Improvement Specialist

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