CDI Specialist I Registered Nurse

4 weeks ago

Orlando FL, United States Orlando Health Full time
CDI Specialist I Registered Nurse - Clinical Documentation - Arnold Palmer Hospital

Position Summary Provides concurrent review of the clinical documentation in the medical record; review the medical record with a clinical lens to identify any missing or understated diagnoses or procedures. This is a hybrid position, hospital will be Arnold Palmer Childrens Hospital Qualifications Education/Training Graduate from an approved school of nursing. Licensure/Certification Maintains current State of Florida RN license or valid eNLC multistate RN license. Experience * Three (3) year acute care hospital experience required. * Extensive clinical knowledge and understanding of pathology/physiology; best demonstrated by clinical experience in hospital setting. Responsibilities Conducts initial and follow-up concurrent reviews on targeted admissions for opportunities to clarify documentation in the medical record for accurate reflection of the acuity of the patient and justifying the level of care. * Coordinates with coding/HIM/UR and other departments to achieve a record that reflects the acuity of the patient and level of care provided. * Review medical record concurrently for documentation not yet in the record but supported by clinical indicators. Performs a thorough chart review to identify co-morbidities/complications, and documents these appropriately within the concurrent CDS worksheet. Determines the appropriate principle diagnosis of the patient. * Demonstrates an understanding of the importance of, and makes an effort to capture, all appropriate secondary diagnoses for quality rating purposes. * Documents findings in workflow tools, noting all key information used in the tracking process. * Uses relationship building and strong communication skills to develop a rapport with providers to clarify information in the medical record. * Uses appropriate querying tools (templates) to capture needed documentation. * Queries the medical staff when necessary by written and/or verbal communication to obtain accurate and complete physician documentation that supports the patient condition(s) and treatment plan Provides education to physicians on the importance of complete documentation and key documentation concepts during regular physician meetings or on individually with physicians. * Reviews the progress of the CDI program by interpreting performance, process, and quality ratings reports. Able to identify areas of focus through report analysis. * Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards. * Maintains compliance with all Orlando Health policies and procedures. Education/Training Graduate from an approved school of nursing. Licensure/Certification Maintains current State of Florida RN license or valid eNLC multistate RN license. Experience * Three (3) year acute care hospital experience required. * Extensive clinical knowledge and understanding of pathology/physiology; best demonstrated by clinical experience in hospital setting. Conducts initial and follow-up concurrent reviews on targeted admissions for opportunities to clarify documentation in the medical record for accurate reflection of the acuity of the patient and justifying the level of care. * Coordinates with coding/HIM/UR and other departments to achieve a record that reflects the acuity of the patient and level of care provided. * Review medical record concurrently for documentation not yet in the record but supported by clinical indicators. Performs a thorough chart review to identify co-morbidities/complications, and documents these appropriately within the concurrent CDS worksheet. Determines the appropriate principle diagnosis of the patient. * Demonstrates an understanding of the importance of, and makes an effort to capture, all appropriate secondary diagnoses for quality rating purposes. * Documents findings in workflow tools, noting all key information used in the tracking process. * Uses relationship building and strong communication skills to develop a rapport with providers to clarify information in the medical record. * Uses appropriate querying tools (templates) to capture needed documentation. * Queries the medical staff when necessary by written and/or verbal communication to obtain accurate and complete physician documentation that supports the patient condition(s) and treatment plan Provides education to physicians on the importance of complete documentation and key documentation concepts during regular physician meetings or on individually with physicians. * Reviews the progress of the CDI program by interpreting performance, process, and quality ratings reports. Able to identify areas of focus through report analysis. * Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards. * Maintains compliance with all Orlando Health policies and procedures.

  • CDI Specialist III Registered Nurse

    1 month ago

    Orlando, United States Orlando Health Full time

    CDI Specialist III Registered Nurse - Clinical Documentation - Orlando HealthPosition Summary Provides concurrent review of the clinical documentation in the medical record; review the medical record with a clinical lens to identify any missing or understated diagnoses or procedures. This is a hybrid role Responsibilities Conducts initial and follow-up...

  • CDI Specialist III Registered Nurse

    1 month ago

    Orlando, FL, United States Orlando Health Full time

    CDI Specialist III Registered Nurse - Clinical Documentation - Orlando HealthPosition Summary Provides concurrent review of the clinical documentation in the medical record; review the medical record with a clinical lens to identify any missing or understated diagnoses or procedures. This is a hybrid role Responsibilities Conducts initial and follow-up...

  • CDI Specialist I Registered Nurse

    4 weeks ago

    Orlando, United States Orlando Health Full time

    CDI Specialist I Registered Nurse - Clinical Documentation - Arnold Palmer HospitalPosition Summary Provides concurrent review of the clinical documentation in the medical record; review the medical record with a clinical lens to identify any missing or understated diagnoses or procedures. This is a hybrid position, hospital will be Arnold Palmer Childrens...

  • CDI Specialist I Registered Nurse

    1 week ago

    Orlando, FL, United States Orlando Health Full time

    CDI Specialist I Registered Nurse - Clinical Documentation - Arnold Palmer HospitalPosition Summary Provides concurrent review of the clinical documentation in the medical record; review the medical record with a clinical lens to identify any missing or understated diagnoses or procedures. This is a hybrid position, hospital will be Arnold Palmer Childrens...

  • CDI Specialist I Registered Nurse

    4 weeks ago

    Orlando, FL, United States Orlando Health Full time

    CDI Specialist I Registered Nurse - Clinical Documentation - Arnold Palmer HospitalPosition Summary Provides concurrent review of the clinical documentation in the medical record; review the medical record with a clinical lens to identify any missing or understated diagnoses or procedures. This is a hybrid position, hospital will be Arnold Palmer Childrens...

  • CDI Specialist III Registered Nurse

    5 days ago

    Orlando, FL, United States Orlando Health Full time

    Position Summary Provides concurrent review of the clinical documentation in the medical record; review the medical record with a clinical lens to identify any missing or understated diagnoses or procedures. Qualifications Education/Training Graduate from an approved school of nursing. Licensure/Certification Maintains current State of Florida RN...

  • CDI SPECIALIST III REGISTERED NURSE

    3 weeks ago

    Orlando, FL 32801, USA, United States Orlando Health Full time

    Position SummaryProvides concurrent review of the clinical documentation in the medical record; review the medical record with a clinical lens to identify any missing or understated diagnoses or procedures.QualificationsEducation/TrainingGraduate from an approved school of nursing.Licensure/CertificationMaintains current State of Florida RN license or valid...

  • Registered Nurse Specialist I

    2 days ago

    Orlando, FL, United States University of Central Florida Full time

    Registered Nurse Specialist I (TEMP) The Opportunity: The UCF Student Health Team is seeking qualified candidates for a Registered Nurse Specialist I position. The Registered Nurse Specialist I will provide professional culturally competent nursing care to patients. The Registered Nurse Specialist I will practice under the oversight of a licensed healthcare...

  • Registered Nurse Specialist I

    2 days ago

    Orlando, FL, United States University of Central Florida Full time

    The Opportunity: The UCF Student Health Team is seeking qualified candidates for a Registered Nurse Specialist I position. The Registered Nurse Specialist I will provide professional culturally competent nursing care to patients. The Registered Nurse Specialist I will practice under the oversight of a licensed healthcare provider, practice nursing...

  • Registered Nurse Specialist I

    23 hours ago

    Orlando, United States University of Central Florida Full time

    Registered Nurse Specialist I (TEMP)The Opportunity: The UCF Student Health Team is seeking qualified candidates for a Registered Nurse Specialist I position. The Registered Nurse Specialist I will provide professional culturally competent nursing care to patients. The Registered Nurse Specialist I will practice under the oversight of a licensed healthcare...

  • Registered Nurse Specialist I

    1 day ago

    Orlando, FL, United States University of Central Florida Full time

    Registered Nurse Specialist I (TEMP)The Opportunity: The UCF Student Health Team is seeking qualified candidates for a Registered Nurse Specialist I position. The Registered Nurse Specialist I will provide professional culturally competent nursing care to patients. The Registered Nurse Specialist I will practice under the oversight of a licensed healthcare...

  • Company Nurse

    1 week ago

    Orlando, FL, United States University of Central Florida Full time

    Registered Nurse Specialist I (TEMP) The UCF Student Health Team is seeking qualified candidates for a Registered Nurse Specialist I position. The Registered Nurse Specialist I will provide professional culturally competent nursing care to patients. The Registered Nurse Specialist I will practice under the oversight of a licensed healthcare provider,...

  • REGISTERED NURSE SPECIALIST

    3 weeks ago

    Gainesville, FL 32635, USA, United States State of Florida Full time

    This is a Registered Nurse Specialist position which is responsible for the supervision and coordination of all nursing services to an assigned group of people in a facility for the developmentally disabled. This position is responsible for the coord Registered Nurse, Specialist, Registered, Nurse, Staff, Nursing, Healthcare

  • REGISTERED NURSE SPECIALIST

    3 weeks ago

    Fort Myers, FL, USA, United States State of Florida Full time

    Requisition No: 827770 Agency: Children and Families Working Title: REGISTERED NURSE SPECIALIST - 60057238 Pay Plan: Career Service Position Number: 60057238 Salary: $53,566.50 Posting Closing Date: 05/03/2024 Total Compensation Estimator Tool Regist Registered Nurse, Specialist, Registered, Nurse, Medical, Benefits, Healthcare

  • 68061416 - REGISTERED NURSE SPECIALIST SURVEYOR

    2 weeks ago

    Miami, FL 33222, USA, United States State of Florida Full time

    Requisition No: 820717 Agency: Agency for Health Care Administration Working Title: 68061416 - REGISTERED NURSE SPECIALIST SURVEYOR Pay Plan: Career Service Position Number: 68061416 Salary: $2,010.28 biweekly Posting Closing Date: 05/20/2024 Total C Registered Nurse, Surveyor, Specialist, Registered, Nurse, Healthcare

  • New Grad Registered Nurse in Florida

    2 days ago

    Orlando, FL, United States K.A. Recruiting Full time

    Looking for a New Grad RN job? My name is Leah and I'm a healthcare recruiter, I'm here to help! I have a New Grad Registered Nurse Program Position position available near Orlando, Florida! Details- Full-time and permanent- Shift: Many available- Op Registered Nurse, Registered, Nurse, Healthcare, Staffing, RN

  • Registered Nurse

    4 weeks ago

    Orlando, United States Vitas Healthcare Full time

    Registered Nurse (RN)PRIMARY FUNCTION The Registered Nurse, RN, is a member of the interdisciplinary team who work together to meet the physical, medical, psychosocial, emotional and spiritual needs of hospice patients and families facing terminal illness and bereavement. The Registered Nurse, RN, is designated to provide coordination of care, ensure...

  • Registered Nurse I Pool

    2 days ago

    Miami, FL, United States Encompass Health Rehabilitation Hospital of Miami Full time

    Registered Nurse I Pool The Registered Nurse provides direct patient care to inpatients. This position assesses patients and creates a plan of care that is individualized and is reflective of each patient's needs and goals. The Registered Nurse supervises activities of care, treatment and services of patient provided by LPN/LVNs, RNTs/CNAs, and other...

  • Registered Nurse I

    2 days ago

    Naples, FL, United States Encompass Health Rehabilitation Hospital of Naples Full time

    Registered Nurse I The Registered Nurse provides direct patient care to inpatients. This position assesses patients and creates a plan of care that is individualized and is reflective of each patient's needs and goals. The Registered Nurse supervises activities of care, treatment and services of patient provided by LPN/LVNs, RNTs/CNAs, and other staff...

  • Registered Nurse I Pool

    2 weeks ago

    Miami, FL, United States Encompass Health Rehabilitation Hospital of Miami Full time

    Registered Nurse I Pool Registered Nurse Career Opportunity Encompass Health: Where Nursing Meets Heart, Home, and Healing Are you seeking a nursing career deeply rooted in purpose, close to your heart and home? Encompass Health offers a transformative journey where your expertise as a Registered Nurse becomes an integral part of patients' recoveries....