Determine the medical necessity of all admissions and the need for continued stay. Monitor for inappropriate or untimely clinical services and patient’s progress on the established clinical paths. Develop an appropriate discharge plan for those patients identified as likely to require some form of continuing care. Consults with the Physician Advisor; addresses documentation issues to assure continuity of quality care rendered to all patients and to meet all Regulatory Agency Requirements.
Reviews inpatient and observation patient charts while the patients are in hospital. Determines from chart review issues that require further physician documentation in the medical record to assist with overall documentation accuracy. Will query the physician on key documentation issues.
Works with Medical Records coding personnel and clinical personnel to determine proper physician queries based on clinical indicators.
Assesses cases for appropriate care, utilization of resources, and length of stay and facilitates transition between levels of care.
Handles crisis situations and counseling to patients regarding adjustment to illness. Handles
self professionally in dealing with patient and family.
Job Type: Full-time
Experience:
- medical records, billing, charge master: 2 years (Preferred)
- utilization review, discharge planning: 2 years (Preferred)
- clinical documentation: 2 years (Preferred)
License: