Top 7 Utilization review nurse Jobs in Bainbridge, Ga

Clinical Documentation Specialist RN
Houston Methodist —Georgia
- Full-time
- Nursing
- RN License
- Customer service
1d
REGISTERED NURSE SPECIALIST - 60005422
The State of Florida —Chattahoochee, FL
- $2,036.36 - $2,454.25 a week
- Background check
- Nursing
- Anatomy knowledge
- Paid holidays
- Dental insurance
REGISTERED NURSE SPECIALIST - F/C - 67044209 APD/ DDDP CHATTAHOOCHEE, FL
The State of Florida —Chattahoochee, FL
- $2,633.05 - $2,891.92 a month
- Weekends as needed
- Background check
- Nursing
- Anatomy knowledge
- Paid parental leave
- Paid holidays
Director Of Nursing
Management & Training Corporation —Quincy, FL
- $97,000 a year
- Full-time
- CPR Certification
- Nursing
- Clean driving record
- AD&D insurance
- Paid holidays

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Clinical Documentation Specialist RN
Houston Methodist —Georgia
RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure – Must obtain permanent Texas license within 60 days (if…
1d
REGISTERED NURSING CONSULTANT - 64035640
The State of Florida —Tallahassee, FL
Must have a valid driver’s license. Through the Department's VALOR program, which expedites licensing for military veterans, the Department also waives initial…
$53,000 - $60,000 a year
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Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Exp. in the delivery of a health services program or…
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Clinical Documentation Specialist RN

Houston Methodist -
Georgia

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Job Details

Full-time
1 day ago

Qualifications

Direct patient care
Customer communication
RN License
English
Acute care experience

Full Job Description

At Houston Methodist, the Clinical Documentation Specialist RN position is responsible for improving the overall quality and completeness of clinical documentation. This position analyzes medical records for DRG's, complications, and comorbidities; identifies trends; and notes observations and recommendations for documentation improvement. This Clinical Documentation Specialist RN position also facilitates modifications to clinical documentation through extensive interaction with physicians, nursing staff, other patient care givers, and medical records coding staff to ensure that appropriate reimbursement is received for the level of service rendered to all patients. Additional duties for this position include supporting the accuracy and completeness of the clinical information used for measuring and reporting physician and hospital outcomes and educating all members of the patient care team on an ongoing basis.

FLSA STATUS
Exempt

QUALIFICATIONS

EDUCATION

Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certifications, Licenses and Registrations section

EXPERIENCE

Five years of recent clinical experience caring for adults in an acute care hospital setting
Coding and utilization review experience preferred

LICENSES AND CERTIFICATIONS
Required

RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure – Must obtain permanent Texas license within 60 days (if establishing Texas residency)

Preferred

CCDS - Clinical Documentation Specialists (ACDIS) or
CDIP - Certified Documentation Integrity Practitioner (AHIMA) or
CCS - Certified Coding Specialist (AHIMA)

KNOWLEDGE AND ABILITIES

Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing skills, competency assessments, and performance evaluations
Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
Demonstrates knowledge of DRG payor issues, appropriate DRG assignment alternatives, clinical documentation requirements, and referral policies and procedures
Demonstrates accountability and professional development
Excellent observation skills, analytical thinking, problem solving, plus good verbal and written communication
Regular significant contacts with other personnel throughout the institution (including but not limited to physicians and their staff, mid-level providers, mid-level staff, coders, Case Managers). Contacts may be in person, by telephone, or through correspondence

ESSENTIAL FUNCTIONS

PEOPLE ESSENTIAL FUNCTIONS

Improves the overall quality, completeness and accuracy of clinical documentation by performing open record reviews using clinical documentation guidelines.
Supports the accuracy and completeness of clinical information used for measuring and reporting physician and medical outcomes.

SERVICE ESSENTIAL FUNCTIONS

Seeks additional information regarding clinical condition from appropriate clinical personnel and follows up as necessary.
Tracks responses and trends completion of DRG/Documentation worksheets as pertinent to scope of department.
Conducts follow-up reviews of clinical documentation to ensure points of clarification have been recorded in the patient’s chart.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

Demonstrates knowledge of DRG payor issues, optimization strategies, clinical documentation requirements and referral policies and procedures.
Requests clarification and/or correction from physicians for unclear diagnoses, complications, procedures, and clinical information.
Helps identify appropriate ICD10 codes for diagnoses or procedures related to projects or studies being conducted as needed.

FINANCE ESSENTIAL FUNCTIONS

Promotes clarification to clinical documentation to ensure that appropriate reimbursement is received for the level of service rendered to all patients.
Identifies diagnoses and procedures performed and comorbidities and complications.
Impacts discharges by updating the DRG worksheet to reflect any changes in status, procedures/treatments, conferring with physician to finalize diagnosis as necessary.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS Educates all internal customers on clinical documentation opportunities, coding, and reimbursement issues, as well as performance improvement methodologies.

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

- Uniform: No
- Scrubs: No
- Business professional: Yes
- Other (department approved): No

ON-CALL*

- Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below.
- On Call* No

TRAVEL**

**Travel specifications may vary by department**

- May require travel within the Houston Metropolitan area No
- May require travel outside Houston Metropolitan area No

QUALIFICATIONS

EDUCATION

Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certifications, Licenses and Registrations section

EXPERIENCE

Five years of recent clinical experience caring for adults in an acute care hospital setting
Coding and utilization review experience preferred

LICENSES AND CERTIFICATIONS
Required

RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure – Must obtain permanent Texas license within 60 days (if establishing Texas residency)

Preferred

CCDS - Clinical Documentation Specialists (ACDIS) or
CDIP - Certified Documentation Integrity Practitioner (AHIMA) or

Company Profile:

Houston Methodist is one of the nation’s leading health systems and academic medical centers. The health system consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the Texas Medical Center, seven community hospitals and one long-term acute care hospital throughout the Greater Houston metropolitan area. Houston Methodist also includes a research institute; a comprehensive residency program; international patient services; freestanding comprehensive care clinics, emergency care and imaging centers; and outpatient facilities. Come lead with us!

Houston Methodist is an Equal Opportunity Employer.

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utilization review nurse jobs in bainbridge, ga

Clinical Documentation Specialist RN

REGISTERED NURSE SPECIALIST - 60005422

REGISTERED NURSE SPECIALIST - F/C - 67044209 APD/ DDDP CHATTAHOOCHEE, FL

Director Of Nursing

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