Clinical Denial RN - Clinical Performance - FT - Day

100 Stormont-Vail HealthCare, Inc.; United States; On-site; USD 65,000 - 90,000; Full time

Job summary

Stormont Vail Health in Kansas is seeking a full-time Clinical Documentation Improvement (CDI) auditor with a BSN to perform clinical audit and validation of medical records, ensuring documentation and coding accuracy to support reimbursement and quality standards.

You will collaborate with the Physician Advisor, conduct root cause analyses, review inpatient and outpatient records, and educate staff on audit outcomes and process improvements while adhering to regulatory acts.

Qualifications

• BSN required.
• 3 years of clinical experience in acute care.
• CDI experience required.

Responsibilities

• Collaborate with the Physician Advisor on documentation improvement and medical necessity.
• Perform root cause analysis and recommend change management.
• Review prospective and retrospective audits across inpatient and outpatient services.
• Educate staff on audit outcomes and process improvements.

Skills

Clinical audit

Nursing

Healthcare documentation

Education

BSN

Job description

Position Status: Full time Shift: First Shift (Days - Less than 12 hours per shift) (United States of America) Hours per week: 40 Job Information Exemption Status: Non-Exempt

A Brief Overview Performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered to patients is complete, compliant, and accurate to support optimal reimbursement and meet quality standards. Application of prospective and retrospective medical claims audit criteria, and clinical and financial review of medical records including but not limited to inpatient facility bill audits, provider offices and clinics, pharmacy and other specialties to ensure that services billed were rendered and documented, at the appropriate level, and meet quality standards. Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management.

Education Qualifications Bachelor's Degree of Science in Nursing (BSN).

Preferred Experience Qualifications 3 years Clinical experience in an acute care setting.

Required CDI experience.

Preferred Licenses and Certifications Registered Nurse - KSBN Required.

What you will do Works collaboratively with the Physician Advisor to, documentation improvement, and medical necessity principles in performance of medical audit activity and applies principles of objectivity in performance of medical audit activity. Perform root cause analysis and submit recommendations for appropriate change management when clinical validation audits and interpretation of medical documentation indicates lack of member access and provider involvement to manage chronic risk conditions. Receives, reviews, verifies, and processes requests for prospective and retrospective audits including but not limited to inpatient hospitalizations, diagnostic testing, outpatient procedures and services, home health care services, durable medical equipment, rehabilitative therapies, and pharmacy reviews from finance and/or claims department. Provides feedback and process improvement recommendations to appropriate health plan operations departments and participates in workgroups/committee meetings and process. Provides clinical interpretation and guidance to fellow auditors and internal staff. Responsible for file maintenance including entry into database for tracking and trending audit results. Educates provider services, health services, finance, and other department staff on the outcomes of the audit results and assists provider services with educational efforts. Provides feedback and process improvement recommendations to appropriate health plan operations departments and participates in workgroups/committee meetings and process improvement solutions as required. Advises manager of possible trends in inappropriate utilization (under and/or over), and other quality of care issues. Responsible for file maintenance including entry into database for tracking and trending audit results. Maintains professional license and certifications Performs other functions as required. Demonstrates knowledge of the Kansas State Nurse Practice Act and follows the statutes and regulations therein. Demonstrates appropriate delegation of tasks and duties in the direction and coordination of health care team members, patient care and department activities in accordance with the Kansas State Nurse Practice Act.

Required for All Jobs Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health Performs other duties as assigned.

Patient Facing Options Position is Not Patient Facing

Remote Work Guidelines Workspace is a quiet and distraction-free allowing the ability to comply with all security and privacy standards. Stable access to electricity and a minimum of 25mb upload and internet speed. Dedicate full attention to the job duties and communication with others during working hours. Adhere to break and attendance schedules agreed upon with supervisor. Abide by Stormont Vail’s Remote Worker Policy and will review and acknowledge the Remote Work Agreement annually.

Remote Work Capability Hybrid Scope No Supervisory Responsibility No Budget Responsibility

Physical Demands Balancing: Occasionally 1-3 Hours Carrying: Occasionally 1-3 Hours Climbing (Stairs): Rarely less than 1 hour Eye/Hand/Foot Coordination: Frequently 3-5 Hours Feeling: Occasionally 1-3 Hours Grasping (Fine Motor): Occasionally 1-3 Hours Grasping (Gross Hand): Occasionally 1-3 Hours Handling: Occasionally 1-3 Hours Hearing: Frequently 3-5 Hours Kneeling: Rarely less than 1 hour Lifting: Occasionally 1-3 Hours up to 10 lbs Pulling: Occasionally 1-3 Hours up to 10 lbs Pushing: Occasionally 1-3 Hours up to 10 lbs Reaching (Forward): Occasionally 1-3 Hours up to 10 lbs Reaching (Overhead): Rarely less than 1 hour up to 10 lbs Repetitive Motions: Frequently 3-5 Hours Sitting: Frequently 3-5 Hours Standing: Occasionally 1-3 Hours Stooping: Rarely less than 1 hour Talking: Frequently 3-5 Hours Walking: Occasionally 1-3 Hours Working Conditions Noise/Sounds: Rarely less than 1 hour

Stormont Vail is an equal opportunity employer and adheres to the philosophy and practice of providing equal opportunities for all employees and prospective employees, without regard to the following classifications: race, color, ethnicity, sex, sexual orientation, gender identity and expression, religion, national origin, citizenship, age, marital status, uniformed service, disability or genetic information. This applies to all aspects of employment practices including hiring, firing, pay, benefits, promotions, lateral movements, job training, and any other terms or conditions of employment. Retaliation is prohibited against any person who files a claim of discrimination, participates in a discrimination investigation, or otherwise opposes an unlawful employment act based upon the above classifications.

Stormont Vail Health is a nonprofit integrated health system that has been serving the health care needs of Kansas for more than 130 years. Stormont Vail has been recognized as a Magnet organization since 2009 by the American Nurses Credentialing Center. It is composed of Stormont Vail Hospital, a 586-bed acute care hospital, and Cotton O’Neil Clinic, a multi-specialty physician group with more than 500 providers, which includes more than 250 physicians. Nearly 5,300 employees provide care and support services for patients in the hospital and 35 other locations, including the Cotton O’Neil Heart Center, Cancer Center, Diabetes & Endocrinology Center, Digestive Health Center, Pediatrics clinics and 10 regional primary care clinics. Stormont Vail Health is committed to its mission of improving the health of the community by being a national leader in providing compassionate, high quality and efficient integrated care through collaboration that results in a healthier community.