Registered Nurse (RN) - Clinical Document Improvement Specialist
Crouse Hospital
Syracuse, NY

Registered Nurse - CDI Specialist

The Clinical Documentation Improvement Specialists (CDIS) report to the Director of Health Information Management.# The CDS is responsible for reviewing medical records to facilitate the accurate representation of severity of illness.# This involves extensive record review, interaction with physicians, HIM professionals and nursing staff.# Active participation in team meetings and education of staff of the Clinical Documentation Management Program is a key role.# The CDS is also responsible for facilitating the improvement of inpatient medical record documentation within the established coding guidelines of regulatory standards, including Medicare and Medicaid.# Ensures corporate compliance standards are maintained.# Meets hospital and department guidelines for timeliness and accuracy.# Assist HIM management team in promoting the Mission, Vision, and Values of the hospital. # Job Requirements: Required: IF HIRED OR LICENSED AFTER 1/1/2017: Graduate of an accredited Nursing degree. #MUST complete BSN (Bachelors in Nursing within 8 years of hire date into the Registered Nurse position).# Currently licensed as a Registered Professional Nurse in New York State. If hired as a Graduate Nurse, a NYS limited licensure work permit must be obtained within ninety (90) days of graduation and the GN must successfully pass the NCLEX exam within 120 days of the beginning of employment to obtain the required professional nursing licensure with New York State. Basic Life Support (BLS) certification required at time of hire or within 6 weeks after hire. Experience: Strong clinical expertise in critical care or med/surg unit with a minimum of five (5) years acute care experience in an inpatient setting required.# Must have the ability to pass clinical competency test with a score of 70 or above.# Test will be administered by Human Resources.## Certification in a specialty area preferred. # The Clinical Documentation Improvement Specialists (CDIS) report to the Director of Health Information Management. The CDS is responsible for reviewing medical records to facilitate the accurate representation of severity of illness. This involves extensive record review, interaction with physicians, HIM professionals and nursing staff. Active participation in team meetings and education of staff of the Clinical Documentation Management Program is a key role. The CDS is also responsible for facilitating the improvement of inpatient medical record documentation within the established coding guidelines of regulatory standards, including Medicare and Medicaid. Ensures corporate compliance standards are maintained. Meets hospital and department guidelines for timeliness and accuracy. Assist HIM management team in promoting the Mission, Vision, and Values of the hospital. Job Requirements: Required: IF HIRED OR LICENSED AFTER 1/1/2017: Graduate of an accredited Nursing degree. MUST complete BSN (Bachelors in Nursing within 8 years of hire date into the Registered Nurse position). Currently licensed as a Registered Professional Nurse in New York State. If hired as a Graduate Nurse, a NYS limited licensure work permit must be obtained within ninety (90) days of graduation and the GN must successfully pass the NCLEX exam within 120 days of the beginning of employment to obtain the required professional nursing licensure with New York State. Basic Life Support (BLS) certification required at time of hire or within 6 weeks after hire. Experience: Strong clinical expertise in critical care or med/surg unit with a minimum of five (5) years acute care experience in an inpatient setting required. Must have the ability to pass clinical competency test with a score of 70 or above. Test will be administered by Human Resources. Certification in a specialty area preferred.