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Clinical Documentation Improvement and Utilization Management Specialist
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Clinical Documentation Improvement and Utilization Management Specialist

Job Snapshot

Employment Type Full-Time
Job Type Health Care
Education Not Specified
Experience Not Specified
Manages Others Not Specified
Industry Healthcare - Health Services
Required Travel Not Specified

Job Description


The CDI and UM Specialist will facilitate and obtain appropriate physician documentation for any clinical conditions or procedures to support the appropriate severity of illness, expected risk of mortality, and complexity of care of the patient.  The individual will exhibit a sufficient knowledge of clinical documentation requirements, DRG assignment, and clinical conditions or procedures.  Individual will educate members of the patient care team regarding documentation guidelines, including attending physicians, allied health practitioners, nursing, and care management.

Job Requirements

The qualified candidate will have experience in the following areas:

  • Minimum of 5 years of clinical healthcare experience in an acute care hospital
  • Knowledge base of ICD-10-CM coding and understanding of Diagnostic Related Groups (DRGs) required
  • Minimum 5 years recent health information management, case management / utilization / quality review and/or other related clinical experience in an acute care facility required; 3 years acute care inpatient coding experience preferred
  • Minimum of 2 years of acute care case management experience preferred
  • Minimum of 2 years of acute care clinical documentation specialist experience preferred
  • Knowledge of PC based computer software (i.e Word, Excel, Access or similar system) preferred

Minimum Education Required/Preferred:

  • Graduate of an accredited school of nursing or Health Information Management program
  • BSN, RHIA or RHIT preferred

Knowledge, Skills, and Competencies:

  • Working knowledge of Microsoft computer applications; excel, word, PowerPoint, etc.
  • Excellent written, verbal and presentation skills required; excellent business judgment, decision making, and business savvy are also essential.
  • Experience working collaboratively with IT, HIMS, and Clinical Operations are important.
  • Strong understanding and appreciation for the automation of the revenue cycle functions and the engagement of the customer in that automated process.
  • Knowledge of applied statistics, process analysis, and outcomes analysis



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Clinical Documentation Improvement and Utilization Management Specialist

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