Job Summary:

Performs record review (quantitative and qualitative) and assesses the level of compliance with stated regulatory requirements by area of job focus. Assigns a working MS-DRG/APR-DRG or diagnosis specific review criteria for CORE measure decision trees within the set time frames. May also review inpatient and outpatient records as part of the hospital wide medical record review program for the Joint Commission. Captures and maintains the related review data in designated computer systems or databases. Assists in clarifying clinical information used for measuring and reporting physician and medical center outcomes which incorporates current DRG methodologies (e.g. MS-DRGs, etc.) by CMS and/or other regulatory/quality reporting bodies (e.g. APR-DRGs, SOI, ROM, etc.). Issues queries to members of the patient care team – primarily physicians – regarding possible diagnoses or to improve the specificity of diagnoses thru enhanced clinical documentation. Facilitates modifications to clinical documentation as needed to support component stated previously.

Educational Requirements:

High School Diploma/GED Required. 
Bachelor's Degree in Nursing or Health Information Management Preferred
Foreign Medical Degree, MBBS, MBBCH will be considered.

Licenses:

RN State License  -Current RN license (not limited to State of California) or higher clinical degree (i.e. MD), or Registered Health Info Admin, or Registered Health Info Tech Required;
Clinical Documentation Improvement Professional - or Certified Clinical Documentation Specialist Preferred

Experience:

Acute Care Experience - 3 Years Required
Utilization Review, Coding, or Case Management experience – Preferred

Physical Demands:

Sit at a desk or table with some walking, standing, bending, stooping, or carrying of light objects - Frequently
Perform continuous operation of a personal computer for four hours or more. - Constantly
Use hands and fingers to handle and manipulate objects and/or operate equipment. -Constantly
Bend, crouch, stoop, stretch, or crawl. Bend upper torso and reach up and out with hands and arms. – Rarely