Medicare Risk Adjustment Chart Review Jobs in Wisconsin

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Location: US:WI:MILWAUKEE at our FROEDTERT HOSPITAL facility.

This job is REMOTE.

FTE: 1.000000

Standard Hours: 40.00

Shift: Shift 1

Shift Details: No holidays or weekends

Job Summary:

The RN Second-Level CDI & Quality Reviewer is a senior-level clinical documentation professional responsible for performing in-depth, concurrent and retrospective reviews of medical records to ensure accurate documentation that supports correct Diagnosis-Related Group (DRG) assignment and other quality-based outcomes. In addition to validating query appropriateness and documentation practices, this role analyzes Patient Safety Indicators (PSIs), Hospital-Acquired Conditions (HACs), and other publicly reported hospital quality metrics. This position works collaboratively with CDI, coding, quality, and provider teams to minimize preventable quality flags and improve overall documentation quality.

EXPERIENCE DESCRIPTION:

A minimum of 5 years of acute care and 3 years of experience in CDI and/or inpatient quality/coding review. Experience working with PSI/HAC analytics or risk adjustment tools (e.g., 3M, Vizient, Midas, Epic SlicerDicer). Experience in audit or quality departments in acute care settings.

Bachelor's degree in nursing or foreign trained medical graduate is required. In lieu of BSN, an Associate's degree in nursing and a Bachelor's in a relevant field may be substituted. Master's degree is preferred.
SPECIAL SKILLS DESCRIPTION:

Demonstrated expertise in clinical documentation standards, MS-DRG/APR-DRG methodology, and AHRQ PSI/HAC methodologies. Familiarity with CMS quality programs (e.g., Hospital Compare, STAR ratings, IQR, Value-Based Purchasing). Strong analytical, communication, and critical thinking skills.

Current state of WI Registered Nurse license or current license from a participating state in the Nurse Licensure Compact. Advanced certification related to CDI (CCDS, CDIP, or CCS) is required. CCS or RHIA credential a plus.

Compensation, Benefits & Perks at Froedtert Health

Pay is expected to be between: (expressed as hourly) $38.92- $60.33. Final compensation is based on experience and will be discussed with you by the recruiter during the interview process.

Froedtert Health Offers a variety of perks & benefits to staff, depending on your role you may be eligible for the following:

• Paid time off
• Growth opportunity- Career Pathways & Career Tuition Assistance, CEU opportunities
• Academic Partnership with the Medical College of Wisconsin
• Referral bonuses
• Retirement plan - 403b
• Medical, Dental, Vision, Life Insurance, Short & Long Term Disability, Free Workplace Clinics
• Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work life benefits available

The Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin's only academic medical center and adult Level I Trauma center engaged in thousands of clinical trials and studies. The Froedtert & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation.

We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce. We welcome protected veterans to share their priority consideration status with us at 262-439-1961. We maintain a drug-free workplace and perform pre-employment substance abuse testing. During your application and interview process, if you have a need that requires an accommodation, please contact us at 262-439-1961. We will attempt to fulfill all reasonable accommodation requests.