Provides clinically based concurrent and retrospective review of inpatient medical records documentation for utilization, severity of illness, risk of mortality and identifies opportunities for improving the quality of medical record documentation and confers with the caregiver regarding additional documentation required. Reviews are determined both internally and by requirements/requests of external payers or regulatory agencies. Reports quality of care outcomes and obtains accurate and compliant reimbursement for acute care services. Educates members of the patient care team regarding documentation guidelines. Collects clinical documentation improvement data for analysis and report generation. Facilitates and enhances the coding and DRG process alignment between physicians and coding staff.
Three years recent critical care experience in an acute care hospital setting, three years recent Case Management and/or Utilization Review experience in acute care hospital setting (OR) five years recent Medical/Surgical experience in an acute care hospital setting required.
Education & Training:
Graduate of a school of nursing. Bachelor's degree in nursing or related field preferred.
Kentucky RN license (OR) RN license in a State recognized by the Kentucky Nurse Licensure Compact Act required effective June 1, 2007.