Clinical Documentation Specialist RN, 0.8 FTE exempt, Days, can be remote after orientation, but must reside within approximately 1 hour driving distance of the Rock Island, IL hospital for orientation, trainings, and meetings. UnityPoint Health affiliate employees living farther will be considered, but must still be within driving distance for orientation and trainings. Current licensure in Illinois and Iowa required. Three to five years clinical experience in acute care, intermediate care or home care required. An internet-based exam is required and must be passed as a part of the screening process. Responsible for concurrent and retrospective review of selected inpatient medical records to facilitate complete and accurate documentation of patient conditions, diagnoses, and procedures. Communicates with physicians and providers to clarify clinical documentation to accurately reflect severity of illness, risk or mortality, and intensity of services provided. Identifies diagnostic and procedure codes through use of established coding guidelines. Promotes communication and collaboration among all members of the health care team.
UnityPoint Health team members come for a job, but stay for a career. As a team member, you'll get the chance to change lives on a daily basis in order to deliver the Best Outcome Every Patient, Every Time- regardless of your position. That privilege drives employees' passion for making a difference in the lives of our patients, helping them create healthier, more rewarding lives. UnityPoint Health sets high expectations for team members in order to establish a trusted team capable of taking on the toughest of challenges.
Demonstrates competence in the skills, (processes, procedures, and equipment) necessary to carry out assigned duties as identified below.
DEMONSTRATION OF VALUES:
Consistently demonstrates Trinity’s values in the performance of job duties and responsibilities.
PRINCIPLES OF HOSPITALITY: Consistently demonstrates Trinity’s co-workers, visitors, and others.
EDUCATION, TRAINING & EXPERIENCE: RN required. BSN or equivalent advanced degree preferred. Three to five years clinical experience in acute care, intermediate care or home care required. Utilization review, case management, and/or coding experience preferred.
KNOWLEDGE, ABILITIES & SKILLS: Knowledge of Medicare regulations and hospital documentation requirements. Knowledge of pathophysiology, clinical issues, and disease processes. Effective verbal and written communication skills. Effective interpersonal skills to establish strong working relationships with all members of the health care team. Organizational, analytical, and critical thinking skills. Self-directed with ability to work with minimal supervision in an outcome oriented environment. Proficiency with key board skills, electronic documentation, various software, and computer use.
LICENSES, REGISTRATIONS AND CERTIFICATIONS: RN's must hold a
current licensure by the Illinois and Iowa State Board of Nursing Examiners.