[Hiring] Registered Nurse Clinical Documentation Educator/Auditor @Northeast Georgia Health System

Role Description

The Auditor-CDI Nurse Educator participates in the daily activities of the Clinical Documentation Department and facilitates documentation improvements to ensure accurate depiction of clinical services and patient severity actively present during patient encounters. The Auditor-CDI Nurse Educator performs department audits, 2nd level reviews, orientation, training and education of CDI staff and supports development of focused provider education. Maintains knowledge of program metrics and helps support timely, accurate data reporting. The Auditor-CDI Nurse Educator contributes to the effective use of 3M-360 applications by accessing and identifying learning needs of CDI nurses, residents, physicians, and administrative staff.

Qualifications

• Current Registered Nurse license in State of GA.
• Certification required - Clinical Documentation Specialist (CCDS).
• Bachelors Degree.
• Five (5) to ten (10) years clinical nursing experience.
• Three (3) to five (5) years experience clinical documentation experience.

Requirements

• Comprehensive knowledge in acute med-surg, critical care, cardiology nursing.
• Must be comfortable operating independently in a collaborative, shared leadership environment.
• Excellent communication (verbal and written), interpersonal, collaboration skills.
• Demonstrates critical thinking, effective prioritization and organization skills.
• Ability to educate the healthcare team on clinical documentation.
• Excellent computer skills, including MS Office applications.
• Experience with databases, spreadsheets/presentation software.
• Ability to develop and implement a strategic direction and vision for project management & priority of work.
• Advanced analytical skills in areas of health information workflow analysis and planning.
• Demonstrates knowledge of the fundamentals of hospital organization/administration and the laws applicable to health information management and CDI.
• Knowledge of Medicare Part A and Part B with the ability to understand and communicate differences between Part A and Part B guidelines.
• Communicate concise, understandable terms with all people involved in the development and implementation of applications both orally and in writing.

Essential Tasks and Responsibilities

• Provide day-to-day educational support for clinical documentation program priorities.
• Function in the capacity of Clinical Documentation Specialist when not involved in educational activities.
• Reviews CDS productivity reports and meets quarterly with each CDS team member.
• Manages the reconciliation process to ensure tasks are completed accurately and timely.
• Conducts internal audits to provide CDI feedback, promote data accuracy, and identify performance improvement opportunities.
• Manage process flow and oversees the communication and education plan.
• Coordinate and work effectively with other Clinical Documentation Specialists, CDI Associate, Admin Support, and Manager.
• Partner with Director's of HIM and Clinical Documentation Specialists in education development and training for coding guidelines.
• Monitor documentation against "core measure" quality indicators and address documentation opportunities with Physicians, Advanced Health Practitioners, and other appropriate staff.
• Collaborate with patient safety team and coding to maintain accuracy in codes associated with patient safety indicators (PSIS).

Physical Demands

• Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time.
• Weight Carried: Up to 20 lbs, Occasionally 0-30% of time.
• Vision: Heavy, Constantly 66-100% of time.
• Kneeling/Stooping/Bending: Occasionally 0-30%.
• Standing/Walking: Occasionally 0-30%.
• Pushing/Pulling: Occasionally 0-30%.
• Intensity of Work: Occasionally 0-30%.
• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding, Driving.