Role Description The Clinical Documentation Improvement Specialist is responsible for improving overall quality and completeness of clinical documentation to ensure that the information in the medical record accurately reflects the patient's severity of illness, clinical needs, and utilization of resources. - This position is responsible for reviewing death medical records to ensure the severity of illness and risk of mortality has been captured at the highest level. - This position works with the providers of care to capture the clinical care in a code format for reimbursement and to ensure UAMS has the correct case mix. - Reviews all admission types to the hospital to ensure severity is captured and then educates the providers of care on admission types. Qualifications - Registered Nurse (RN) with current license plus 4 years inpatient clinical experience in Emergency, Critical Care, or Medical/Surgical area with experience in Quality, Case Management, Clinical Audit, or Data Abstraction OR Coding professional with CCS certification and 6 years of inpatient coding experience with documented education in anatomy/physiology and pharmacology. - CCDS is required within 6 months of hire. - Current CCDS (preferred). Requirements - Applies extensive clinical knowledge to read and analyze health record documentation, identifying all significant diagnoses, treatment, and procedures impacting acuity level and resources consumed throughout the current hospitalization. - Applies knowledge of disease processes, surgical procedures, UHDDS definitions, and the CMS/NCHS ICD-10 Official Coding Guidelines for Coding and Reporting to assign non-indexed terms to the appropriate class within the ICD-10 coding classification system. - Reviews all death medical records and works with Vizient calculator to ensure risk of mortality and severity of illness scores are correct. - Interacts directly with physicians, nursing staff, other patient caregivers, coding staff, and other members of the health care team to facilitate clarification of clinical documentation and transfer of knowledge related to accurate documentation, coding, and reimbursement practices. - Develops and facilitates education related to clinical documentation improvement, coding guidelines, and regulatory requirements to all members of the healthcare team through one-on-one communication and classroom or large group presentations throughout the year as assigned. - Performs other duties as assigned. Benefits - Health: Medical, Dental and Vision plans available for qualifying staff and family. - Holiday, Vacation and Sick Leave. - Education discount for staff and dependents (undergraduate only). - Retirement: Up to 10% matched contribution from UAMS. - Basic Life Insurance up to $50,000. - Career Training and Educational Opportunities. - Merchant Discounts. - Concierge prescription delivery on the main campus when using UAMS pharmacy. Company Description The University of Arkansas for Medical Sciences (UAMS) has a unique combination of education, research, and clinical programs that encourages and supports teamwork and diversity. We champion being a collaborative health care organization, focused on improving patient care and the lives of Arkansans.

• Responsible for improving overall quality and completeness of clinical documentation • Ensure that the information in the medical record accurately reflects the patient's severity of illness, clinical needs, and utilization of resources • Review death medical records to ensure the severity of illness and risk of mortality has been captured at the highest level • Work with the providers of care to capture the clinical care in a code format for reimbursement and to ensure UAMS has the correct case mix • Review all admission types to the hospital to ensure severity is captured and then educate the providers of care on admission types.

• Supervises daily operations of the CDI program for the Health Ministries (HMs) within the region. • Provides direct oversight of the Clinical Documentation Specialist and Clinical Documentation Integrity Coordinator. • Ensures that defined goals are accomplished utilizing timely and compliant processes within the region. • Trains and educates clinical documentation specialists (CDS) to enhance clinical and coding skill sets. • Responsible for scheduling and work assignments for colleagues. • Collaborates with Clinicians, Coding, Quality and Denials teams to facilitate documentation within the medical record.

Role Description Utilizes a collaborative review process of benefits, minimally necessary clinical information and evidence-based clinical guidelines to formulate decisions regarding medical necessity, pre-existing conditions, benefits and/or individual consideration reimbursement allowables using varied and broad clinical expertise. Acts as a member and provider advocate promoting and coordinating delivery of quality, cost-effective healthcare services based on medical necessity and contractual benefits. The candidate for this position must reside in the Kansas City metropolitan area. - Conducts pre-service, concurrent and/or post-service utilization management reviews to ensure appropriate use of the health care system and to maximize health care dollars. - Schedules time effectively; works with minimal supervision; handles multiple projects simultaneously; prioritizes work appropriately to streamline process and identifies opportunities for quality or process improvement. - Uses critical thinking skills, problem solving and organizational skills; works as a team member while maintaining a positive attitude. - Ensures that reviews and determinations meet requirements with applicable URAC and NCQA guidelines as well as federal and state mandates. - Maintains confidentiality of all PHI in compliance with state and federal laws. - Reads, understands and follows medical policy and all corporate, divisional and departmental policies and procedures. - Reviews provider and/or member submitted medical information to determine pre-existing, medical necessity, benefits & eligibility, and/or reimbursement of a requested service, product or procedure. - Refers cases that do not meet criteria to the Medical Director with an appropriate clinical analysis, summaries and recommendations. - Contributes in the discharge planning of members to appropriate acute, SNF, in-patient hospice or rehab facilities or discharge to home with a safe plan. - Recognizes, documents and reports inappropriate billing patterns or utilization trends of professional and institutional providers to the appropriate business owner. - Communicates effectively with team members, other departments within the organization, management, members &/or providers. - Assesses and educates members &/or providers on a proactive basis; utilizes internal, community and other healthcare resources as well as clinical knowledge to maximize outcomes. - Contributes to reaching or exceeding departmental, divisional and corporate goals. - Knowledgeable of business goals, progress toward accomplishment of goals and works collaboratively with peers to meet or exceed annual departmental targets. - Analyzes qualitative and quantitative data in developing strategies to improve provider performance and member satisfaction. Qualifications - Associate degree in nursing. - 3+ years full-time direct patient care clinical experience in medical/surgical, pediatrics, and/or obstetrics. - Proven experience effectively presenting information and responding to questions from groups of managers, clients, customers, and the general public. - Proven experience in problem definition, data collection to establish facts, and drawing valid conclusions to solve practical problems. - RN license in Missouri and Kansas. Preferred Qualifications - Bachelor’s degree in nursing preferred. - 1+ year(s) of utilization review, disease management, and/or case management experience. - Knowledge of ICD, CPT and HCPCS coding. - Knowledge of URAC and NCQA guidelines and state and federal regulations. - Intermediate keyboarding skills. - Intermediate knowledge of FACETS. - Intermediate knowledge of Clinical Guidelines. Benefits - Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute. - Annual incentive bonus plan based on company achievement of goals. - Time away from work including paid holidays, paid time off and volunteer time off. - Professional development courses, mentorship opportunities, and tuition reimbursement program. - Paid parental leave and adoption leave with adoption financial assistance. - Employee discount program.