CDI Quality Review RN

With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report(Opens in a new window), we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you’ll discover a culture of teamwork, professionalism, and a rewarding career!

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. The focus of the Quality Review Nurse will be on identifying and capturing methodology-specific risk variables (Vizient, HCC’s, Elixhauser) on a post-discharge, pre-coding/billing basis, as well as identifying potential process improvements to capture the opportunities concurrently. The Quality Review Nurse will also validate that the record reflects the most appropriate principal diagnosis and diagnosis related group (DRG). The Quality Review Nurse will support the objective for accurate reflection of patient acuity, severity of illness, risk of mortality, and DRG assignment in compliance with industry rules and regulations.

Conduct post-discharge, pre-coding/billing reviews on targeted records identified for second-level review for opportunity to accurately capture methodology-specific risk variables (Vizient, HCCs, Elixhauser); present on admission (POA) status, patient admission source, avoidable patient safety indicators (PSI‿s), and DRG assignment in compliance with industry rules and regulations If a documentation opportunity is identified, place physician query and follow up for response If coding opportunity is identified, coordinate with Coding Team to review and address 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 Maintains an expert level of knowledge of CDI and Coding related guidelines and practices Other duties as assigned