Clin Documentation Spec/UKHC

The Clinical Documentation Specialist will review physician documentation to identify the most appropriate DRG. When evidence supports additional diagnoses not documented in the proper format for final ICD-9 codes, the Clinical Documentation Specialist will clarify information with physician staff to ensure that diagnoses are appropriately documented in the medical record. This function is vital to capture the most accurate clinical picture of severity of illness, risk of mortality, co-morbidities, and complications. The Specialist will also assist in the capture of present-on-admission diagnoses.

This is primarily a remote position with some on-site requirements.

The ideal candidate will have the ability to manage multiple tasks and/or projects while accurately completing routine functions in a fast-paced, high intensity, professional work environment. This individual will also have knowledge of nursing theory; proficiency utilizing Microsoft Office applications; excellent attention to detail; exceptional planning and organizational skills, written and verbal communication skills, and time management and judgement abilities; the ability to solve routine problems and manage resources; and a demonstrated ability to provide superior customer service.

7 yrs

Registered Nurse (RN)

A Bachelor's degree and at least five years of nursing experience are preferred.

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As an Equal Opportunity Employer, we strongly encourage veterans, individuals with disabilities, women, and all minorities to consider our employment opportunities.


Any candidate offered a position may be required to pass pre-employment screenings as mandated by University of Kentucky Human Resources. These screenings may include a national background check and/or drug screen.