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Second Level Review; RN, El Paso Health
1 month ago
Job Summary:
The Second Level Reviewer Registered Nurse plays a pivotal role in conducting critical, high-risk and intricate secondary case reviews that are essential for accurate clinical documentation. This ensures that the severity of illness, expected risk of mortality, and complexity of patient care are properly reflected in provider documentation. By enhancing documentation accuracy, the nurse not only supports optimal patient outcomes but also contributes significantly to hospital initiatives such as reducing Geometric Mean Length of Stay (GMLOS) and improving Case Mix Index (CMI). This collaborative effort with CDI specialists, coders, providers, and other healthcare team members ensures that documentation aligns with organizational standards, enhancing continuity of care and overall patient safety while meeting regulatory compliance requirements.
Minimum Job Requirements:
Work Experience:
Three years of direct patient care in hospital setting required.
Three years of experience working with inpatient clinical documentation, mortality, PSI, HAC, or other quality-focused reviews required.
License/Registration/Certification:
Current Texas Registered Nurse license required.
CCDS or CDIP certification preferred.
Coding certification (CCS, CIC, or CPC) preferred.
Education and Training:
Bachelor's Degree in Nursing required; Master’s degree preferred.
Skills:
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- Extensive clinical knowledge, critical-thinking skills, and understanding of disease processes, pathophysiology, and disease management/treatment.
- Knowledge of Vizient, Premier, US News and World Report, CMS star rating or similar risk-adjustment methodologies highly preferred.
- Proficiency with CDI software (EZDI), CERNER and encoder. Experience with 3M 360 Encompass preferred.
- General knowledge of office procedures and operations.
- Skill in data entry with minimal errors.
- Ability to accurately prepare and maintain records, files, reports and correspondence.
- Ability to communicate effectively in both oral and written form.
- Ability to handle difficult and stressful situations with professional composure.
- Ability to maintain effective interpersonal relationships.
- Ability to understand and follow instructions.
- Proficiency with ICD-10-CM/PCS, APR DRG, and MS DRG required.
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