Clinical Documentation Specialist - RN

This is a Hybrid, Full Time, Day Shift Clinical Documentation Specialist position supporting Northwest Healthcare at Northwest Medical Center!

As a Northwest Healthcare system employee, this individual implements clinical documentation improvement (CDI) activities at assigned CHS facilities to ensure that coded diagnoses are an accurate reflection of the patient’s clinical status and care. Reviews medical record documentation and clinical indicators and works with providers to ensure a complete and accurate medical record. Identifies potential gaps in clinical documentation for inpatient and payer populations as directed throughout the hospitalization. Educates physicians and key healthcare providers regarding clinical documentation improvement and the need for accurate and complete documentation in the health record.

Position Qualifications/Minimum Requirements

Education: ADN or Diploma in Nursing Program, BSN preferred. 

Experience: Required: Five years of acute hospital nursing experience (e.g. medical/surgical unit, intensive care). Preferred: Experience in Utilization Management/Case Management, Critical Care, patient outcomes/quality management and/or inpatient coding, ICU/Critical Care, clinical documentation improvement, ICD coding and MS-DRGs, working in a clinical documentation improvement department or as a consultant and minimum of one (1) year auditing experience .

Licenses/Certifications: Required: Current Arizona RN license or compact state license. Preferred: RHIT, RHIA, CDIP, CDIS, CCDS, CCS and ICD-10 certification or designation. 

Northwest Healthcare (NWHC) is a multi-faceted network dedicated to providing safe, quality care at each of our locations. With four hospitals, two freestanding emergency centers, seven Northwest Urgent Care locations, Northwest Transitions Inpatient Rehabilitation, Skilled Nursing Unit, and a large physician practice including primary care and a variety of specialists, NWHC offers you a wide range of settings in which to work. Common among them all is not only the commitment to providing quality patient care, but to employee satisfaction and growth. Whether caring for patients directly or working in a support role setting, you'll feel the One Northwest culture of teamwork, respect and appreciation for all employees. NWHC is accredited by The Joint Commission and is an equal opportunity employer: race, gender, disability and Veteran status, and VEVRAA Federal Contractor – priority referral Protected Veterans requested.