CDI - RN- Utilization Review/CDI Emergency Department
JOB TITLE: RN- Utilization Review/CDI Emergency Department
SUMMARY OF RESPONSIBILITIES:
Conducts chart assessments on Emergency Department patients on a daily basis; provides clinical information to verify correct status and appropriateness of admit as requested using Interqual Criteria guidelines. Exemplify sound clinical judgment and experience and expertise in area of clinical management and demonstrate skill in clinical chart assessment and ability to communicate effectively with physicians and staff. Communicate with precertification nurse to facilitate on going coverage and work closely with social workers to provide maximum assessment of discharge needs. Participates in interdisciplinary meetings and communicates with staff/treatment/physician team on appropriate interventions; and maintains positive working relationships with staff and other departments to provide optimal quality outcomes within the framework of professional nursing practice. These responsibilities are met according to hospital policy, hospital mission statement and the philosophy of the Department of Nursing. Relative to CDI function: Performs concurrent medical record reviews to facilitate improvement in the quality, completeness and accuracy of medical record documentation to ensure coding compliance, accurate reporting of hospital services and improved patient outcomes. Utilizes appropriate clinical documentation guidelines to identify opportunities for improvement in accuracy and completeness of the medical records and the development and implementation of strategies to inform and educate members of the patient care team. Required knowledge and understanding: Knowledge of ICD9/10 coding, CPT codes and DRG coding required. Clinical Assessment skills, including understanding of disease process and pathophysiology. Understanding of IPPS and documentation impact. Working knowledge of reimbursement systems and coding structures. Proficiency in Microsoft Word, Excel, & Internet Explorer
Also requires basic knowledge and operational skills of computer and office equipment; ability to move around various areas of the hospital quickly / extensive walking; possess the ability and desire to work with individual of all races, ages, lifestyles, disabilities and cultures; excellent oral and written communication skills; and must be willing to work as a member of the total healthcare team.
REPORTING RELATIONSHIPS: Operationally, reports to the Director of Integrated CDI
REQUIREMENTS: 1) Current licensure by the State Board of Nurse Examiners with basic knowledge of appropriate nursing applications 2) Current CPR 3) Three (3) years recent HIM, Case Management/Utilization/quality review and/or other related clinical experience in an acute care facility.
Must have current licensure/certifications upon hire.
New Hires will have 60 days to acquire the required Basic Life Support (CPR, ACLS, PALS, BLS, and/or any other life support certifications required for the job).
OSHA TASK CATEGORY THREE: There is no anticipated risk of exposure to mucous membranes or skin contact with blood, body fluids, or tissues, or a potential for spills or splashed during the performance of the job. Universal precautions must be observed and protective devices worn by the employee when performing a task that is likely to cause exposure.
Employment standards include current requirements as determined by Federal, State, and Wise Health System policy.
EMPLOYEE STATUS: Non-Exempt Hourly