CLINICAL DOCUMENTATION SPECIALIST (DENIAL MANAGEMENT) - Full Time (HYBRID)

Hartgrove Behavioral Health System consists of a 160-bed leading psychiatric hospital dedicated to providing quality behavioral health services for a diverse population of all ages. Hartgrove is a flagship behavioral health facility within Universal Health Services, Inc. and throughout Illinois. Hartgrove is a state-of-the-art facility offering some of the most advanced technologies and programs found in the behavioral health field. We are dedicated to our teamwork approach and provide a highly compassionate and therapeutic environment, as well as offering a continuum of specialty programs throughout our inpatient, partial and outpatient services.

This is a hybrid poisition - 3 days in office/2 days remote.

JOB SUMMARY: The Clinical Documentation Specialist (RN) responsibilities include:

Medical Record Review:

• Improves the overall quality and completeness of clinical documentation by performing chart reviews using clinical document completed by all disciplines.
• Performs thorough daily review of medical records to ensure they accurately reflect the level of care provided and compliance with medical necessity documentation requirements. Conducts concurrent review of medical records to track documentation supporting the severity of the illness and intensity of services.
• Analyzes the medical record regarding the clinical status of patient, current treatment plan and past medical history and seeks clarification of incomplete, unclear, and ambiguous documentation.
• Is responsible for the day-to-day evaluation of documentation by the Medical Staff and clinical treatment team in accordance with the hospital's designated clinical documentation policies and procedures.
• Provides daily clinical evaluation of the medical record including provider and clinical documentation, lab results, diagnostic information and treatment plans.
• Reviews all clinical documentation for improvement and/or quality opportunities

Interdisciplinary Collaboration:

• Develops and implements plans for both formal and informal education of attending provider, nursing, social worker and other clinical staff.
• Provides education and training to staff on clinical documentation best practices and medical necessity criteria.
• Collaborates with attending providers to ensure clinical information is accurately and comprehensively documented.
• Identifies strategies for sustained work process changes that facilitate compete, accurate clinical documentation.
• Intervenes with clinical and Medical Staff to ensure documentation supporting applicable diagnosis.
• Provides education to providers and other clinicians on compliant documentation practices to support medical necessity, severity, reimbursement and continuity of patient care. Acts as an effective change agent and educator for physicians and allied health staff.
• Facilitates clarification to clinical documentation through concurrent interaction with providers and other members of the health care team to support that appropriate clinical severity is captured for the level of service rendered to all inpatients

A Career with Hartgrove Behavioral Health System Offers....

• A rewarding career improving the lives of youth and adults
• Resources of a large health system (UHS, Inc.)
• An engaged leadership team
• A commitment to patient safety
• Career advancement and mobility
• Competitive compensation & benefits package and sign-on bonus
• And much more!

For information about the benefits we offer, please visit UHS Benefits Service Center.

JOB SPECIFICATIONS: To perform this job successfully, an individual must be able to perform each primary duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required.

Education: Minimum BS in Nursing related field from an accredited college.

Experience: Minimum three years of clinical experience a hospital setting .At least one year experience in Utilization Management or knowledge of Medicare, Medicaid and Managed Care preferred

Licensure/Certification: Active Registered Nurse (RN) license

Knowledge: Possesses knowledge of utilization review, insurance and managed care procedures. Comprehensive understanding of medical necessity criteria (InterQual, MCG, CALOCUS, LOCUS, ASAM) for acute inpatient behavioral health. Knowledgeable in behavioral health managed care and clinical assessment skills to align patient acuity with level of care practice guidelines - Diagnostic and Statistical Manual of Mental Disorders (DSM-V).Knowledge of DSM, ICD-10 and clinical best practices for treatment for medical, mental health and chemical dependency diagnoses, across all age spans preferred. Effective oral and written communication skills. Current knowledge of regulating /accrediting agency guidelines. Basic knowledge of computer skills and statistical analysis desired.

Supervision Received: Group Director of UM

Supervision Exercised: None

Line of Promotion: UM Manager

Working Conditions: General hospital environment

Physical Requirements: Sedentary work with occasional lifting required. Important physical capabilities: bending, reaching, standing, listening, verbal skills, pushing, walking and repetitive typing/keying. Must be able to use computer, printer, typewriter and office supplies.

The physical requirements described here are representative of those which must be met by an employee to successfully perform the functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the primary functions.

Job Classification: Exempt

About Universal Health Services

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance, growing since its inception into a Fortune 500 corporation. Headquartered in King of Prussia, PA, UHS has 99,000 employees. Through its subsidiaries, UHS operates 28 acute care hospitals, 331 behavioral health facilities, 60 outpatient and other facilities in 39 U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

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