Clinical Documentation/Quality Specialist
3 weeks ago
Department:
Quality Improvement
FTE (Full Time Equivalent)
0.5 FTE (40 Hours per pay period)
Hours:
Monday thru Friday: Day Shift (Flexible day hours); possible weekend hours
Position Objective
The Clinical Documentation /Utilization Review Quality Specialist is responsible for essential documentation improvement analysis under the direction of the Director of Quality & Risk Management and UR/CDI Physician Advisor. This position will work with CDI and Utilization Review Software programs and directly query physicians. The program goal is to assist Providers with Concurrent Documentation to obtain complete and accurate documentation in the Medical Record. For UR, this position reviews patient charts to ensure patients meet medical necessity for hospitalization and are admitted into the correct admission status.
Essential Responsibilities
The following description of responsibilities to be performed is not intended to be all-inclusive. Rather, it focuses on the major tasks that must be accomplished.
- Perform CDI Reviews in accordance with 3M CDI training and meet all State & Federal Regulations
- Accountable for review of Medicare and Medicare Replacement Insurance reviews for Clinical Documentation Improvement and review additional cases as time allows
- Communicate directly to physicians and providers to improve documentation using CDIS
- Communicate directly to physicians when medical necessity meets, or does not meet insurance approval
- Assist in Quality (Abstracting) & Utilization Review when needed
Other Responsibilities
- Perform all other related duties as assigned in a professional and responsive manner
- Demonstrate the ability to use relevant equipment
- Support, understand, and promote Alomere Health's mission, vision, values, policies and procedures
- Ability to meet the work schedule requirements with flexibility dependent upon the needs of the department
- Foster respectful working relationships with professional colleagues, patients, families, and general public regardless of age, gender, lifestyle, culture, beliefs, race, socioeconomic class, or ability
Required Qualifications
- Graduate of an LPN Nursing Program
- Two years of experience in healthcare
- Active and current registration in the state of Minnesota
Preferred Qualifications
- Experience or training in Clinical Documentation Improvement (CDI), Utilization Review or other Quality-related training
Knowledge, Skills and Abilities
- Attention to detail
- Critical Thinking Skill
- Problem Solving
Union Position:
No
Benefit Status:
Part-Time
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