Clinical Documentation Nurse - Quality

University of Chicago Medicine; Illinois; Remote; USD 70,000 - 95,000; Full time

Job summary

UChicago Medicine in Chicago, IL is seeking a Clinical Documentation Nurse - Quality to join the Office of External Assessments. This role primarily offers remote work from home, with residency in Chicagoland required, and focuses on accurate abstraction, review, and reporting of clinical documentation to support quality improvement, accreditation, and patient safety.

The nurse will use measure specifications and data definitions to review data, engage with clinicians to clarify documentation,

Qualifications

• Current IL Nursing License (RN).
• Minimum of two years direct clinical experience.
• Quality Improvement experience.
• Two years’ experience with TJC/CMS core measures/NSQIP abstraction (preferred).

Responsibilities

• Provide abstraction and analysis of clinical medical record documentation to support clinical measures of care.
• Educate clinical teams and leaders of documentation needs related to clinical measures to guide improvement efforts.
• Engage clinical teams in improvement initiatives through ongoing monitoring and feedback of performance.
• Continual education pertaining to abstraction specifications and inter-rater reliability testing among colleagues.
• Other duties as assigned by manager.

Skills

RN license

Clinical experience

Quality improvement

Education

IL Nursing License (RN)

Job description

Be a part of a world-class academic healthcare system at UChicago Medicineas a Clinical Documentation Nurse - Qualityfor the Office of External Assessments. This position will be primarily a remote work from home opportunity but must reside in Chicagoland.

TheClinical Documentation Nurse – Quality supports clinical performance through accurate abstraction, review, and reporting of clinical documentation to support quality improvement, accreditation, regulatory, and patient safety initiatives. The CDN uses established measure specifications, data definitions, and flowcharts to accurately review and abstract data. The successful candidate engages with clinicians and others to clarify documentation, identify gaps or variances, and provide meaningful feedback that supports accurate clinical documentation and evidence-based care.

Essential Job Functions

Provide abstraction and analysis of clinical medical record documentation to support clinical measures of care

Educate clinical teams and leaders of documentation needs related to clinical measures to guide improvement efforts

Engage clinical teams in improvement initiatives through ongoing monitoring and feedback of performance

Continual education pertaining to abstraction specifications and inter-rater reliability testing among colleagues

Other duties as assigned by manager

Required Qualifications

Current IL Nursing License (RN)

Minimum of two years direct clinical experience

Quality Improvement experience

Preferred Qualifications

Two years’ experience with TJC/CMS core measures/NSQIP abstraction

Knowledge of acute care regulatory/accreditation requirements

• Job Type/FTE: Full-Time
• Shift: Days
• Job Location: Remote
• Unit/Department: Office of External Assessments
• CBA Code: Non-Union

About Us

We’ve been at the forefront of medicine since 1899. We provide superior healthcare with compassion, always mindful that each patient is a person, an individual. To accomplish this, we need employees with passion, talent and commitment… with patients and with each other. We’re in this together: working to advance medical innovation, serve the health needs of the community, and move our collective knowledge forward. If you’d like to add enriching human life to your profile, UChicago Medicine is for you. Here at the forefront, we’re doing work that really matters. Join us. Bring your passion.

UChicago Medicine is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, ethnicity, ancestry, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national origin, age, disability, veteran status and other legally protected characteristics.

As a condition of employment, all employees are required to complete a pre-employment physical, background check, drug screening, and comply with the flu vaccination requirements prior to hire. Medical and religious exemptions will be considered for flu vaccination consistent with applicable law.

Compensation & Benefits Overview

UChicago Medicine is committed to transparency in compensation and benefits. The pay range provided reflects the anticipated wage or salary reasonably expected to be offered for the position.

The pay range is based on a full-time equivalent (1.0 FTE) and is reflective of current market data, reviewed on an annual basis. Compensation offered at the time of hire will vary based on candidate qualifications and experience and organizational considerations, such as internal equity. Pay ranges for employees subject to Collective Bargaining Agreements are negotiated by the medical center and their respective union.