Top 13 Clinical documentation & utilization review nurses Jobs in Spring Hill, Fl

Quality CDI
Access Healthcare Physicians, LLC —Spring Hill, FL
- From $20 an hour
- Full-time
- Background check
- RN License
- Mid-level
- Health savings account
- AD&D insurance
Quick Apply
Clinical Care Manager Asst - LPN
Gulfside Healthcare Services, Inc. —New Port Richey, FL
- Background check
- Customer service
- Mid-level
Quick Apply
7d
MDS Coordinator - RN
Bear Creek Nursing —Hudson, FL
- Weekends as needed
- Background check
- Skilled nursing facility
- RN License
- Free parking
- Health savings account
Quick Apply
Electronic Medical Records Coordinator
Blue Heron —Wesley Chapel, FL
- Full-time
- Mid-level
- LPN
- Health insurance
- Dental insurance
Quick Apply
MDS Coordinator Nurse
Trinity Regional Rehab Center —Trinity, FL
- Full-time
- Background check
- Nursing
- Skilled nursing facility
- Paid holidays
- Health insurance
Quick Apply
11d
Claims Nurse (Utilization Management / Claims Review) Must have CALIFORNIA license
Dragonfly Global —United States
- $100,000 - $105,000 a year
- Full-time
- Remote
- LVN
- RN License
- Mid-level
- Travel reimbursement
- Health savings account
Quick Apply

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Quality CDI

Access Healthcare Physicians, LLC
Spring Hill, FL

Quick Apply

Job Details

Full-time
From $20 an hour

Benefits

Health savings account
AD&D insurance
Health insurance
Dental insurance
401(k)
Flexible spending account
Paid time off
Parental leave
Employee assistance program
Vision insurance
401(k) matching
Life insurance
Referral program
Retirement plan
Prescription drug insurance

Qualifications

Medicare
Electronic health records (EHR) management
RN License
Health education for healthcare providers
CMS
Patient management software
CMS regulatory compliance
Clinical staff training
Health insurance knowledge
Medicare regulations
NCQA standards
Risk management
Clinical documentation
Productivity software
Medicare stars
Clinical documentation standards

Full Job Description

Clinical Quality & Documentation Improvement Specialist (RN/LPN)

Access Health Care is seeking an experienced Clinical Quality & Documentation Improvement Specialist to join our growing Quality Department. This role is ideal for a clinically licensed professional who is passionate about quality improvement, value-based care, population health, risk adjustment, and provider education.

The ideal candidate will have a strong clinical background and experience with NCQA, CMS, HEDIS, 5-Star, ACO, Risk Adjustment, and Clinical Documentation Improvement (CDI) initiatives.

Position Summary

The Clinical Quality & Documentation Improvement Specialist is responsible for monitoring, auditing, and improving clinical documentation, coding accuracy, quality outcomes, utilization management, and regulatory compliance. This position partners closely with providers and office staff to support quality measures, close care gaps, improve patient outcomes, and optimize organizational performance.

Essential Responsibilities

Monitor and audit medical record documentation for compliance with NCQA and CMS specifications.
Support and lead initiatives related to HEDIS, CMS Star Ratings, ACO measures, and value-based care programs.
Work quality gap reports and assist with closure of care gaps for 5-Star, HEDIS, and ACO quality measures.
Conduct clinical documentation and coding audits to ensure compliance with ICD-10, CPT, CMS, and payer guidelines.
Educate providers and staff on documentation improvement, coding compliance, and quality measure requirements.
Assist with Medicare Risk Adjustment and chronic condition management initiatives.
Analyze quality and utilization data to identify opportunities for improvement.
Collaborate with Care Management, Case Management, providers, and leadership to improve patient outcomes.
Support quality improvement projects, audits, and regulatory compliance activities.
Review and validate quality measure data within EMR and reporting systems.
Serve as a subject matter expert for quality, compliance, documentation improvement, and coding initiatives.

Required Qualifications

Current Florida RN or LPN License.
Minimum of three (3) years of clinical healthcare experience.
Minimum of two (2) years of experience in one or more of the following:
Quality Management
HEDIS
Medicare Advantage
Risk Adjustment
Clinical Documentation Improvement (CDI)
Utilization Management
Population Health
Care Management
Medical Coding Compliance

Required Knowledge

Candidates must possess working knowledge of:

NCQA Standards
CMS Guidelines
HEDIS Measures
CMS 5-Star Programs
ACO Quality Measures
Medicare Advantage Programs
Risk Adjustment Methodology
Clinical Documentation Improvement Practices
ICD-10 and CPT Coding Guidelines

Required Skills

Ability to review and analyze medical records.
Strong clinical assessment and critical thinking skills.
Excellent verbal and written communication skills.
Strong organizational and time-management abilities.
Ability to educate and engage providers and clinical staff.
Proficiency with EMR/EHR systems and Microsoft Office applications.
Ability to travel between assigned practice locations as needed.

Preferred Certifications

One or more of the following certifications is preferred:

CPC (Certified Professional Coder)
CRC (Certified Risk Adjustment Coder)
CCDS (Certified Clinical Documentation Specialist)
CDIP (Certified Documentation Improvement Practitioner)
CPHQ (Certified Professional in Healthcare Quality)
CCM (Certified Case Manager)

Candidates without certification must be willing to obtain a CPC, CRC, CCDS, or CDIP certification within 12 months of hire.

Why Join Access Health Care?

Competitive salary
Comprehensive benefits package
Professional growth and development opportunities
Collaborative team environment
Meaningful impact on patient outcomes and quality performance
Opportunity to work in a value-based care organization focused on excellence

Job Type: Full-Time

License Required: Active Florida RN or LPN License

Preferred Experience: HEDIS, Medicare Advantage, Quality Improvement, Risk Adjustment, Clinical Documentation Improvement, Population Health, and Provider Education.

Experience Level: Mid-Level to Senior Clinical Quality Professional

Work Location: Travel between assigned practice locations as needed.

Pay: From $20.00 per hour

Benefits:

401(k)
401(k) matching
AD&D insurance
Dental insurance
Employee assistance program
Flexible spending account
Health insurance
Health savings account
Life insurance
Paid time off
Parental leave
Prescription drug insurance
Referral program
Retirement plan
Vision insurance

Experience:

HEDIS: 1 year (Required)
NCQA standards: 1 year (Required)
Medicare stars: 1 year (Required)
Risk management: 1 year (Preferred)
Clinical documentation: 1 year (Required)

License/Certification:

LPN (Preferred)
RN License (Preferred)

Work Location: In person

Quick Apply

Refine Your Search

clinical documentation & utilization review nurses jobs in spring hill, fl

Quality CDI

Clinical Care Manager Asst - LPN

MDS Coordinator - RN

Electronic Medical Records Coordinator

MDS Coordinator Nurse

Claims Nurse (Utilization Management / Claims Review) Must have CALIFORNIA license

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