Travel Nurse RN - Clinical Document Improvement Specialist
Beaverton, OR
ALOIS Healthcare
5x8 hrs, Days

Clinical Documentation Specialist RN – Beaverton, OR

• Location: Beaverton, OR
• Assignment: REMOTE
• Time Zone: Must be located in the Pacific Time Zone
• Shift: Day, 5x8s
• Schedule: Monday–Friday, 8:00 AM–5:00 PM
• Start Date: ASAP
• Contract Length: 13 weeks
• Hours: Full-time through October; possibility of reduced hours afterward based on need
• First-Time Travelers: Accepted

Requirements

• RN license: Oregon RN license must be active/in hand at submission
• BLS required
• Clinical Experience: 5 years required
• Utilization Review or Quality Assurance: 2 years required
• Medical Case Management: 2 years preferred
• Managed Care or Workers’ Compensation: 2 years preferred
• Education: MSN preferred
• EPIC experience: Preferred
• Travel experience: Not required

Key Clinical Documentation Skills

• Acute hospital experience
• Concurrent and retrospective review
• Clinical documentation improvement
• Physician queries and query resolution
• Verbal and written physician queries
• ICD-10 and CPT coding
• Denials and audits
• Severity of Illness (SOI)
• Hospital Acquired Conditions (HAC)
• Detection of complications/secondary diagnoses
• Review of H&P and discharge summaries
• Management of physician responses
• Clinical staff education/training
• HIPAA compliance

Primary Responsibilities

• Perform utilization management and medical necessity reviews
• Evaluate appropriateness of requested health services
• Develop and update medical policies, criteria, and treatment protocols
• Conduct prospective and retrospective reviews
• Consult with physicians, medical directors, and committees
• Identify and investigate quality-of-care issues
• Coordinate with Health Plan Utilization Management and Care Management teams
• Provide case management and treatment interventions
• Support cost-effective care and early return to work for workers’ compensation cases
• Analyze provider profiling and benchmarking data
• Develop provider education and quality improvement plans
• Provide medical consultation and training to non-clinical staff
• Track disputed surgical cases and prepare litigation reports
• Identify cases requiring catastrophic case management
• Code diagnoses/procedures and document review findings
• Maintain timely and accurate review documentation
• Participate in Quality Committee and continuous quality improvement activities
• Review provider medical records and assist with quality improvement programs