RN CLINICAL DOCUMENT CASE MANAGER - CDI SPECIALIST (CLINICAL DOCUMENTATION INTEGRITY)

Monday - Friday 7 am - 3:30 pm, fully remote Job Summary The Clinical Documentation Case Managers are experienced nurses with clinical skills and knowledge in the application of documentation compliance necessary to support patient severity and corresponding organizational reimbursement. There is an expectation of a high level of understanding of the DRG reimbursement process and ICD-10 CM coding guidelines. The position is responsible for the improvement in overall quality, accuracy and completeness of clinical documentation, and assures all documentation describes each patient’s clinical condition as accurately as possible and supports the level of service provided. The incumbent assists to facilitate the required level of detail in clinical documentation by educating and communicating extensively with the Medical Staff, other members of the health care team and Medical Records coding staff and demonstrates improvement in metrics such as CMI, Core Measure compliance, volume of Medical Record coding queries, etc. Education Minimum: Graduate of a Registered Nurse Program Preferred: Bachelor Degree in Nursing Registration/Certification/Licensure : Current PA RN license Preferred: ACDIS credentialed, Certified Coding Specialist, RHIT, or RHIA Experience Minimum: Three years of current medical/surgical/acute care nursing experience or two years of inpatient coding experience. Preferred: Documentation Compliance/Coding/DRG experience. Other Requirements : N/A Status : Non-Exempt Physical Requirements: The following frequency definitions apply to all Physical Requirements unless otherwise noted: Occasional: (0-1/3 of day , 0 - 2.5 hrs/day, 1 - 4 reps/hr) Frequent: (1/3 -2/3 of day , 2.5 - 5.5 hrs/day, 5 -24 reps/hr) Constant : (> 2/3rd of day , > 5.5 hrs/day, > 24 reps/hr) xxxxx NOTE: An asterisk (*) indicates that the item is an essential function. Non-Material Handling Standing* • Remaining on one's feet in an upright position remaining stationary - FREQUENT Walking* • Remaining upright on one's feet, and moving about - FREQUENT Sitting* • Body remains in a seated position - FREQUENT Stooping* • To bend the body downward and forward by bending the spine at the waist - OCCASIONAL Bending* • To flex the upper body forward - OCCASIONAL Twisting* • To rotate the upper body forward - OCCASIONAL Climbing* • To move the body in any direction on equipment or structures that do not include stairs or ladders - N/A Ladders* • To ascend and descend ladders - N/A Stairs* • To ascend and descend stairs - FREQUENT Kneeling* • To move the body downwards and come to rest on both hands and both knees - OCCASIONAL Squatting* • To move the body downwards by bending both knees - OCCASIONAL Crouching* • To bend the body forward and downward by bending the spine and the legs - OCCASIONAL Crawling* • To move the body forward or backwards on hands and knees - N/A Reaching Horizontal* • To extend the arms and hands outward, remaining under shoulder height - OCCASIONAL Reaching Overhead* • To extend the arms and hands up and out over shoulder height - OCCASIONAL Grasping* • Using functional gripping of the hand to handle an object - CONSTANT Finger Manipulation* • To manipulate objects with the use of fingers - CONSTANT Seeing* • Using visual feedback to accomplish a task or activity - CONSTANT Hearing* • Using sound feedback to accomplish a task or activity - CONSTANT Repetitive Upper Extremity Use* • Using the arms and/or hands continuously or more than 2/3 of the total time - CONSTANT Repetitive Lower Extremity Use* • Using the legs and/or feet continuously or more than 2/3 of the total time - CONSTANT Material Handling Pushing* • To exert a force upon an object in order to move it in a certain direction Pushing refers to moving an object away from theperson CONSTANT Up to 20# Pulling* • To exert a force upon an object in order to move it in a certain direction Pulling refers to moving an object towards the person CONSTANT Up to 20# Lift* • Floor to Waist CONSTANT Up to 20# Lift* • Waist to shoulder CONSTANT Up to 20# Lift* • Shoulder to overhead CONSTANT Up to 20# Carrying* • To transport an object or article using the arms or hands (> 10 feet) CONSTANT Up to 20# Environmental Factors Working alone

• OCCASIONAL

Working in cramped quarters

• FREQUENT

Constant interruptions

• CONSTANT

Working with hands in water

• N/A

Use of power tools

• N/A

Working on ladders/scaffolding

• N/A

Exposure to vibration

• N/A

Exposure to dust

• N/A

Exposure to noise (constant)

• N/A

Exposure to electrical energy (outlets, etc)

• N/A

Exposure to temperature changes (heat, cold, humidity), that require special clothing

• N/A

Exposure to slippery walking surfaces

• N/A

Exposure to solvents, grease, oils

• N/A

Exposure to radiant energy, ie computer terminal (more than 4 hours per shift)

• CONSTANT

Working with bloodborne pathogens

• N/A

Cardiovascular Energy Requirements - Physical Demand PhysicalDemand MetLevel Examples of similar activity intensity Sedentary toLight 0 - 3.5 Light house cleaning, washing dishes, serving food, food shopping, sitting, standing, computer work. Medium 3.6 - 6.3 House work (mopping, scrubbing), health club exercising, treadmill work, stretching, yoga, walk/run-playwith children, aerobic class, dancing, carrying bucket/wood, auto body repair, shoveling snow, golf(carrying clubs). Heavy to VeryHeavy > 6.4 Calisthenics (push up, pull up, sit up, vigorous effort), carrying groceries upstairs, shoveling coal, bailinghay, fire fighting, sawing by hand, splitting wood. As Relates To This Position: Sedentary to Light - CONSTANT Medium - N/A Heavy to Very Heavy - N/A I. Specific Job Responsibilities Apply To This Job