Remote Utilization Review Rn Jobs in Miami, FL (NOW HIRING)

The Analyst, Clinical Documentation Integrity (CDI) is responsible for reviewing patient medical records to ensure clinical documentation is accurate, complete, and compliant, bridging the gap between clinical care and coding.

To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. The requirements listed below are representative of the knowledge, skills and/or abilities required.

• Strong analytic skills with the ability to interpret clinical documentation, coding guidelines and regulatory requirements. (clinical, operational, process,systems)
• Excellent written and verbal communication skills, particularly in provider querying and education
• Experience in clinician coding and reviewing documentationguidelines
• Ability to work independently in a remote environment, managing multiple priorities and deadlines.
• Strong organizational skills and attention to detail.
• Adaptability in a rapidly evolving healthcare and reimbursement environment.
• Familiarity with various electronic health record (EHR)systems
• Demonstrated ability to communicate effectively with clinicians, nursing staff, and hospitaladministration

Education/Experience

• Associate or Bachelor's degree in nursing, health information management/technology, or related field
• Minimum of 3 years' experience in clinical documentation integrity, coding, case management, utilization review or related clinical roles. Clinical background preferred (RN, LPN, PA,NP

Computer Skills

• Proficiency in Microsoft Office Applications
• Experience with Electronic Health Systems (EHRs) (e.g. Epic, Cerner), preferred
• Familiarity with coding, CDI and analytical tools (e.g. 3M, CAC) a plus.

Certificates and Licenses (if applicable)

• Certified Professional Coder (CPC) or Certified Clinical Documentation Specialist (CCDS), or Clinical Documentation Improvement Specialist (CDI) certification.

If you are ready to join an exciting, progressive company and have a strong work ethic,join our team of experts!We offer a highly competitive salary and a comprehensive benefits package.

Envision uses E-Verify to confirm the employment eligibility of all newly hired employees. To learn more about E-Verify, including your rights and responsibilities, please visitwww.dhs.gov/E-Verify.

Envision is an Equal Opportunity Employer.

These are your responsibilities :

• Reviews medical records concurrently and/or retroactively to ensure documentation is complete, accurate, clinically valid, and compliant with regulatory and organizational standards.
• Collaborates with multiple stakeholders (clinical leadership, revenue cycle, quality team) to create a unified approach for documentation improvement
• Supports documentation improvement initiatives for new sites, underperforming locations, or special projects. Conducts patient record reviews for sites with documentation opportunities and/or new locations to identify documentation gaps or inconsistencies
• Collaborates with providers, coders, Clinical leadership, Revenue Cycle, Compliance, Quality and Audit teams to improve documentation accuracy and alignment.
• Coordinates and participates in site reviews, provider education sessions, and conference calls, including preparation of supporting materials. Work with the CDI specialists to coordinate and schedule conference calls and site reviews/ preparation of materials for meetings
• Communicates coding and documentation-related trends, risks, and opportunities to CDI leadership and Coding partners.
• Supports ad-hoc record reviews for site-specific training
• Tracks and reports CDI activity, query response rates, and education efforts using established tools (e.g., SharePoint dashboards. Monitors and tracks all clinician outreach and training activities
• Assists with denial prevention, audit readiness, and revenue integrity initiatives. Supports revenue cycle metrics and denial prevention efforts
• Communicates coding-related findings weekly via a SharePoint file to coding partners
• Maintains strict adherence to HIPAA, patient confidentiality and data security requirements.
• Other duties as assigned.