Clinical Documentation Specialist RN

About This Role

This Clinical Documentation Specialist RN conducts concurrent utilization review based on medical necessity criteria, collaborating with insurers and payors to certify inpatient care for payment. The role involves managing clinical information and recording interactions in department databases.

Responsibilities

• Conduct concurrent utilization review using knowledge of Milliman and InterQual criteria for medical necessity and appropriateness of setting
• Interact with insurers, third-party payors, and review entities (e.g., EQ Health for Medicaid) to relay clinical information
• Certify inpatient care for payment
• Record all interactions in department databases and software, such as Allscripts

Requirements

• Bachelors Degree
• 3-5 years of previous job-related experience
• Current Registered Nurse License State of Illinois

Qualifications

• Bachelors Degree
• 3-5 years of previous job-related experience

Skills

* Required skills

Benefits