Clinical documentation specialist [h1.location_city]

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Full-Time

Monday-Friday

8am-5pm

Not fully remote.

The Clinical Documentation Specialist (CDS) provides concurrent review of the clinical content in the active patient medical record and queries the medical staff to obtain specific and complete documentation that supports the severity of patient illness and risk of mortality. The CDS conducts initial and extended stay reviews on all selected admissions and identifies opportunities for improvement, education, and increased

Registered professional nurse who assesses, implements or delegates, plans, and evaluates total nursing care and functions in accordance with established philosophy. Relates effectively with other shifts / departments for optimal continuity of care.

Qualifications :

• Graduation from an accredited School of Nursing
• Valid Texas RN License / Eligible Compact License
• Must maintain a current BLS certification from American Heart Association
• Minimum of 5 years of acute care experience.

CDI Certification required within 2 years of eligibility.

Skills and Abilities :

Critical thinking

Strong clinical skills

Excellent written and verbal communication

Knowledge of Medicare reimbursement procedures and rules

Fundamental knowledge of coding practices

UMC Health System provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment on the basis of race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.