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Clinical Documentation Improvement Specialist

Job ID: 95465 Date posted: May 03, 2019

  • Sharp Chula Vista Medical Ctr
  • Clinical Documentation Program
  • Day Job
  • Full-Time

Success Profile

Wondering what qualities it takes to be a successful nursing professional at Sharp? View some of the traits we’re looking for below.

  • Innovative
  • Collaborative
  • Resourceful
  • Advocate
  • Person-Centered
  • Critical Thinker

Responsibilities

Summary
The Clinical Documentation Improvement Specialist (CDIS) reviews inpatient medical records while patients are still in-house (concurrent review) for proper documentation. This review includes new admissions to the facility, as well as re-reviews every two to three days until the patients are discharged. The CDIS communicates with clinicians and physicians to ensure timely and accurate documentation for all designated payer(s) and provides training and education as needed.
The Clinical Documentation Improvement Department is part of Clinical Informatics. This department provides the opportunity to learn new skills, new software, and work closely with physicians, informaticists and coders.
Sharp System Services have campuses located in the communities of Kearny Mesa and Serra Mesa and consist of the Spectrum location, the Ruffin Road location and Sharp Operations Center (SOC). These offices provide the centralized integrated system support services to the operating entities within the system. These services include: Strategic Planning, Business Development, Information Technology, Compliance, Internal Audit, Legal, Risk Management and Insurance, Contracts, Human Resources, Facilities Management and Development, Clinical Effectiveness, Finance, Nursing, Systems Supply Chain Services, Marketing and Communications, The Sharp Experience and Sharp University.
Sharp HealthCare is proud to be an Equal Opportunity/Affirmative Action Employer.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, gender identity, transgender status, sexual orientation, protected veteran status or any other protected class.

Location
This position is located in Chula Vista, CA.
 
Hours
Full Time; Day Shift
 
Required Skills and Qualifications
  • RN, BSN with a minimum of three years’ experience in nursing or other clinical area of an acute care facility
  • Current unencumbered California Registered Nurse license (RN)
  • Strong clinical skills including understanding of clinical disease process, pathophysiology and treatment plans
  • Experience working with an EHR, preferably Cerner Millennium
  • Effective interpersonal skills in order to interact effectively with physicians and all levels of hospital personnel
  • Organization and prioritization skills
  • Effective written and verbal communications skills
  • Analytical skills
  • Proficient with MS Office applications
 
Preferred Skills and Qualifications
  • CDIS certification
  • Emergency or critical care nursing background
  • Working knowledge of regulatory coding guidelines
  • Experience working with Cerner Millennium

Perks

  • Medical, vision and dental

  • Generous time off

  • Flexible schedule

  • Professional growth

  • Wellness Programs

  • Education reimbursement

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Culture/Values

  • Committed to excellence in all that we do
  • Built to be supportive and educational — a place where employees can grow and thrive
  • A positive, compassionate, friendly and team-oriented atmosphere
  • Thankful for the contributions and hard work of others, and praising their accomplishments
  • Committed to creating a safe environment for those we serve
  • Celebrate diversity, recognizing that our unique differences create a stronger whole

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