Job Description Summary
A concurrent reviewer applies clinical and coding knowledge to concurrently evaluate the clinical indicators, diagnoses and treatment plan for assigned inpatients, and identifies potential gaps in physician documentation. The CDI second level reviewer (CDI SLR) is an advanced reviewer who uses his/her extensive Clinical Documentation Integrity (CDI) experience to perform a variety of advanced second level reviews. The CDI SLR will conduct post-discharge reviews prior to final billing for target case populations. These reviews have direct influence on CMI and financial outcomes as well as act as drivers of contribute expected mortality and expected LOS which quality outcomes including Vizient Q&A Ranking. The CDI SLR will also respond to concurrent review requests from CDSs, provide guidance when CDSs and Coders cannot reconcile DRG mismatches, and coordinate with Coders regarding outstanding queries or requests.
Entity
Medical University Hospital Authority (MUHA)
Worker Type
Employee
Worker Sub-Type
Regular
Cost Center
CC002372 SYS - System Quality and Safety
Pay Rate Type
Salary
Pay Grade
Health-31
Scheduled Weekly Hours
40
Work Shift
Job Description
A concurrent reviewer applies clinical and coding knowledge to concurrently evaluate the clinical indicators, diagnoses and treatment plan for assigned inpatients, and identifies potential gaps in physician documentation. The CDI second level reviewer (CDI SLR) is an advanced reviewer who uses his/her extensive Clinical Documentation Integrity (CDI) experience to perform a variety of advanced second level reviews. The CDI SLR will conduct post-discharge reviews prior to final billing for target case populations. These reviews have direct influence on CMI and financial outcomes as well as act as drivers of contribute expected mortality and expected LOS which quality outcomes including Vizient Q&A Ranking. The CDI SLR will also respond to concurrent review requests from CDSs, provide guidance when CDSs and Coders cannot reconcile DRG mismatches, and coordinate with Coders regarding outstanding queries or requests.
Bachelor's or Associate's degree in nursing from an accredited school of nursing and ten years nursing experience preferred; three years of which must include CDI experience. Certification as CDI specialist either from ACDIS or AHIMA required currently or within 6 months of accepting the position. Extensive knowledge of patient care, and knowledge of clinical measurement tools and clinical outcomes; ability to establish cooperative working relationships with diverse groups and individuals, medical staff, and other health care disciplines. Licensure as a registered nurse by the South Carolina Board of Nursing or a compact state.
*Position may require extensive walking.
*May require frequent bending, stooping, or stretching.
*May require lifting and carrying up to 20 lbs.
*Requires eye-hand coordination and manual dexterity.
*Requires the use of office equipment, such as computer terminals, telephones, and copiers.
*Requires normal vision range and the absence of color blindness.
(C) Continuous - 6-8 hours per shift;
2) (F) Frequent - 2-6 hours per shift;
3) (I) Infrequent - 0-2 hours per shift
Ability to perform job functions while standing. (C). Ability to perform job functions while sitting. (C) Ability to perform job functions while walking. (C) Ability to climb stairs. (F) Ability to work indoors. (C) Ability to work outside in temperature extremes. (I) Ability to work from elevated areas. (I) Ability to work in confined/cramped spaces. (F) Ability to perform job functions from kneeling positions. (I) Ability to bend at the waist. (F) Ability to twist at the waist. (F) Ability to squat and perform job functions. (I) Ability to perform "pinching" operations. (C) Ability to perform gross motor activities with fingers and hands. (C) Ability to perform firm grasping with fingers and hands. (C) Ability to perform fine manipulation with fingers and hands. (C) Ability to reach overhead. (I) Ability to perform repetitive motions with hands/wrists/elbows and shoulders. (C) Ability to fully use both legs. (C) Ability to use lower extremities for balance and coordination. (F) Ability to reach in all directions. (C) Ability to lift and carry 50 lbs. unassisted. (I) Ability to lift/lower objects 50 lbs. from/to floor from/to 36 inches unassisted. (I) Ability to lift from 36" to overhead 25 lbs. (I) Ability to exert up to 50 lbs. of force. (I) Ability to see and recognize objects nearby or at a distance. (C) Ability to match or discriminate between colors. (C) Ability to determine distance/relationship between objects; depth perception. (C) Good peripheral vision capabilities. (C) Ability to maintain hearing acuity, with correction. (C) Ability to perform gross motor functions with frequent fine motor movements. (C) Ability to deal effectively with stressful situations. (C) Ability to work rotating shifts. (I) Ability to work overtime as required. (I) Ability to work in a latex safe environment. (C) Ability to maintain tactile sensory functions. (C)
Additional Job Description
Bachelor's or Associate's degree in nursing from an accredited school of nursing and ten years nursing experience preferred; three years of which must include CDI experience. Certification as CDI specialist either from ACDIS or AHIMA required currently or within 6 months of accepting the position. Extensive knowledge of patient care, and knowledge of clinical measurement tools and clinical outcomes; ability to establish cooperative working relationships with diverse groups and individuals, medical staff, and other health care disciplines. Licensure as a registered nurse by the South Carolina Board of Nursing or a compact state.
If you like working with energetic enthusiastic individuals, you will enjoy your career with us!
