RN CDI Specialist — Elevate Hospital Documentation

R1 RCM, Inc.; Lorida (FL); On-site; USD 52,000 - 98,000; Full time

Job summary

R1 RCM Inc. is seeking a Clinical Documentation Improvement (CDI) Specialist to apply clinical and coding knowledge for concurrent and retrospective reviews of inpatient records.

You will identify opportunities to improve documentation quality to support appropriate severity, risk of mortality and resource use. This role requires an active RN license and front line CDI experience in an acute care hospital, with 3–5 years of clinical work in medical-surgical areas such as ICU, telemetry or ED.

Qualifications

• Associate’s Degree in Nursing required; Bachelor’s preferred.
• Active US RN license required.
• Front line CDI experience in an acute care hospital.
• 3–5 years of recent clinical work in medical-surgical, ICU, telemetry or ED.
• Knowledge of EMR and CDI platforms.

Responsibilities

• Initiates physician queries when information is missing or conflicting in the medical record.
• Educates physicians and staff on documentation, coding guidelines and reimbursement.
• Applies coding guidelines and DRG assignment for accurate reflection of severity and resource use.
• Collaborates with coders, auditors and QA teams to resolve documentation issues.
• Stays updated on clinical documentation standards and regulatory changes.
• Conducts focused reviews in Mortality, PSI and other CDI projects.

Skills

CDI practices

RN license

acute care CDI

CMS rules

Education

Associate’s Degree in Nursing

Bachelor’s Degree in Nursing (preferred)

Tools

EMR platforms

CDI platforms

Job description

R1 RCM Inc. is seeking a Clinical Documentation Improvement (CDI) Specialist to apply clinical and coding knowledge for concurrent and retrospective reviews of inpatient records.

You will identify opportunities to improve documentation quality to support appropriate severity, risk of mortality and resource use. This role requires an active RN license and front line CDI experience in an acute care hospital, with 3–5 years of clinical work in medical-surgical areas such as ICU, telemetry or ED.