Job Summary:
This licensed professional nurse (RN) works with the Medical Staff to offer documentation education to secure all legitimate DRG opportunities. He/she works within the scope of case management and utilization review to provide documentation that best represents the patient's clinical findings and treatment plan. This professional is also responsible for data quality review on specified records, resolution of DRG/APG/ASC coding changes with third party payers and provides structured education programs. The candidate must be able to follow standard practices in coding/reimbursement and to optimize payment for all financial schemes. He/she must demonstrate exceptional judgment and organizational ability and possess excellent communication skills, both written and oral.

Education:
Required:
Registered Nurse in the state of TN,

Preferred:
BSN. MSN

Experience:
Required:
The candidate must have a strong clinical background (minimum of five years) in addition to experience in utilization management and familiarity with reimbursement principles. Must be computer literate, experienced in use of Microsoft Office and BHIS/SMS systems.

Preferred:

Position requirements/Licensure:
Required:
Current license to practice nursing in the State of Tennessee.

The Nurse Licensure Compact will not change how to obtain or renew a Tennessee license. However, the Tennessee nursing license will be a single state license for Tennessee Residents or non-compact state residents. Tennessee licensure or multistate licensure from a compact state must be obtained within three months of hire for non-Tennessee residents.

Preferred: N/A

Department Position Summary:
Responsible for communication with the medical staff to improve the quality and clarity of documentation of patients' condition in the medical record. Reduces physician�s workload through assistance with regulatory guides through clinical review. Supports documentation of clinically supported procedures.

The employee must be detail oriented and able to assimilate large quantities of data, analyze the data and provide organized reports on the data. The employee must be able to demonstrate knowledge of problem identification and resolution. The individual must demonstrate the ability and desire to learn intense optimization techniques. The employee must be able to research data gathered and organize the data into a comprehensive educational presentation. The individual must have the professional demeanor needed to present education programs to various audience types. The individual must demonstrate flexibility in the scope and type of work assigned.

The employee in this position must display the ability to be self motivated, able to evaluate the scope of each day's work and display time management skills to accomplish the work evaluated. The employee must keep her/his licensure current by participating in continuing education.