CDI Quality Review RN

Job Summary Position: CDI Quality Review RN - (948267). The CDI Quality Review Nurse (QRN) will work under the direction of the Clinical Documentation Integrity (CDI) Manager and conduct second-level reviews of targeted cases to identify and capture opportunities to improve the integrity of the medical record. Focus on methodology‑specific risk variables (Vizient, HCC, Elixhauser) on a post‑discharge, pre‑coding/billing basis and validate that the record reflects the most appropriate principal diagnosis and diagnosis related group (DRG). Supports accurate reflection of patient acuity, severity of illness, risk of mortality, and DRG assignment in compliance with industry rules and regulations. Responsibilities Conduct post-discharge, pre-coding/billing reviews on targeted records to accurately capture methodology-specific risk variables (Vizient, HCC, Elixhauser); present on admission (POA) status, patient admission source, avoidable patient safety indicators (PSI), and DRG assignment in compliance with industry rules and regulations. When a documentation opportunity is identified, place physician query and follow up for response. When a coding opportunity is identified, coordinate with Coding Team to review and address the opportunity, as applicable. Utilize methodology-specific risk calculators and guidance documents to understand if additional diagnoses and/or risk variables will impact the reported quality impact of a specific patient encounter. Maintain a summary of opportunities identified through second-level review for feedback and education with the CDS Team, Providers, and Coding Team. Identify and communicate any process improvement opportunities for front-end correction and education. Periodically review the criteria established for cases triggering a second-level review and recommend updates or modifications to the criteria to maximize impact on quality scores. Maintain an expert level of knowledge of CDI and Coding related guidelines and practices. Other duties as assigned. Qualifications (Required) Experience 5 years patient care nursing experience in an acute care setting and 3 years Clinical Document Integrity experience. Licenses and Certifications Registered Nurse (RN) upon hire. Clinical Documentation Specialist (CCDS) or Certified Clinical Documentation Improvement Practitioner (CDIP) upon hire. Preferred Qualifications Education Master's Degree in Nursing. Experience 7 years patient care nursing experience in an acute care setting, 5 years Clinical Document Integrity experience, and experience working in a remote environment. Benefits PPO medical plan, available day one at no cost for full-time employee-only coverage. Paid Time Off, available day one. Retirement Programs through the Teacher Retirement System of Texas (TRS). Paid Parental Leave Benefit. Wellness programs. Tuition Reimbursement. Public Service Loan Forgiveness (PSLF) Qualified Employer. Security and EEO Statement Security This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information. Equal Employment Opportunity UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal-opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status. #J-18808-Ljbffr The University of Texas Southwestern Medical Center