Clinical Documentation Specialist - Utilization Management (Full-Time, Days)

Enloe Health; Chico (CA); On-site; USD 71,000 - 96,000; Full time

Benefits offered by this job

Vision insurance

Medical plan with 0 premium

Retirement with employer match

PTO accrues from start

Extended Sick Leave

Flexible Spending Accounts

Employee Assistance Program

Educational Assistance

Job summary

Enloe Health in Northern California is seeking a Clinical Documentation Specialist (CDS) to review medical records and ensure accurate representation of illness severity. You will collaborate with physicians, HIM and clinical staff to clarify documentation discrepancies in a timely manner.

Five years of inpatient acute care nursing experience is required. Hold a California RN license with CPR, CCDS or eligibility, and CDI/critical care experience is preferred.

Qualifications

• Five years inpatient acute care nursing experience.
• CDI Experience is preferred.
• Critical Care Experience is preferred.
• Bachelor’s or Master’s degree, in nursing.
• Experience in hospital operations, management and physician relations.

Responsibilities

• Review medical records to facilitate accurate representation of illness severity.
• Interact with physicians, clinical staff and HIM professionals to identify documentation improvements and timely clarifications.
• Participate in Task Force Meetings and help develop education for medical staff.

Skills

CDI Experience

Critical Care Experience

Verbal & Written Communication

HIPAA Compliance

Team Collaboration

Education

Bachelor’s or Master’s degree in nursing

Job description

ENL Utilization Management

Compensation Range: $51.76 - $69.88

Your rate of pay will be based on applicable experience

Shift: Days

Shift length: 8 Hours

Days off: Saturday & Sunday

Hours per pay period: 80 Hours

Enloe Health is a Level II Trauma Center located in beautiful Northern California. We offer a full array of medical services, and our mission is to elevate the health of the communities we serve. As a Planetree organization, we place high value on hiring the right team to care for our patients and their families—care that is steeped in compassion, human connection, and mutual support. If you feel called to make a meaningful impact through empathetic, person-centered care, and thrive in a culture that values collaboration and purpose, we welcome you to join our team.

Position Summary

The Clinical Documentation Specialist (CDS) is responsible for reviewing medical records to facilitate the accurate representation of the severity of illness. This involves the extensive record review, interaction with physicians, clinical staff, and HIM professionals. Utilizing advanced clinical knowledge, the CDS role requires the ability to review the medical record accurately and timely, recognize opportunities for documentation improvements, formulate clinically credible documentation clarifications, follow-up timely on all cases, especially those requiring clinical documentation clarifications, and communicate effectively and appropriately with the physicians. The CDS participates in the Task Force Meetings and collaborates on developing education for medical staff.

Minimum

EDUCATION / TRAINING / EXPERIENCE

• Five years inpatient acute care nursing experience

Desired

• CDI Experience
• Critical Care Experience
• Bachelor’s or Master’s degree, in nursing
• Experience in hospital operations, management and physician relations

Minimum

LICENSES / CERTIFICATIONS

• Current licensure with the California Board of Registered Nursing
• Current CPR certification
• CCDS Certification (or must obtain when eligible to test) (dept tracks)

Skills / Knowledge / Abilities

Must have excellent verbal and written communication skills and advanced critical thinking skills and be able to maintain strong, positive working relationships with medical staff. Understands and supports the CDI documentation strategies and concepts. Demonstrates advanced clinical expertise including understanding of nursing anatomy/pathophysiology, disease processes, pharmacology, advanced critical thinking, deductive reasoning and problem solving skills. Demonstrates organizational, analytical and interpersonal skills. Requires strict HIPPA compliance. Demonstrates ability to interact with a wide variety of individuals and handle multiple priorities. Proficiency in computer use, including database programs, presentation programs, word processing and internet search. Ability to work independently, be self-motivated, and adaptable to changes in work environment. Must be able to interact professionally with various colleagues and foster a team environment. Must be able to perform the essential functions of the position.

Benefits Information

Enloe offers a comprehensive and competitive benefits package to all eligible employees, including, but not limited to:

• $0 premium medical plan to include vision insurance
• Prescription and dental group insurance
• Retirement with employer match
• Generous paid time off (PTO) plan that starts accruing immediately and can be used as it's earned
• Extended Sick Leave
• Flexible Spending Accounts for unreimbursed medical expenses and dependent care
• Employee Assistance Program
• Educational Assistance