Quality review/HEDIS nurse vs. Clinical Documentation Specialist

  1. Hi all,

    I was wondering if anyone has done either or both of the above jobs and if so which is more fulfilling.

    I have a job offer for a large insurance company for a quality review nurse position. I would be going around to PCP offices to abstract information from charts on diabetic patients. This would be 40% of the time. Then the remaining time I would be working from home entering the data in the system and calling patients with HgA1c greater than 9 for a brief phone call to see how they're doing, why they may not be following up with their PCP (if they're not), do they need another one, are they getting necessary labs and preventative testing done and if they need further education I will refer to disease management or the diabetic educator. Also I would be trained to do HEDIS when that comes up in March.

    So I was all set to take this job and then I got a call from a large university hosp in my area for a clinical documentation specialist job. I had that interview on Friday. The job sounds interesting. They are adding 4 more clin doc spec to the existing 4 as they will now be reviewing peds charts along with adults. Your day is spent pulling up the census and dividing it amongst the nurses and reviewing 20-25 charts a day (concurrent and some retro). Then the 8 of us would be rotating giving power point presentations to the doctors (different groups like urology etc and interns and residents when they come on). I know alot of clin doc specs do rounds and 1:1's with doctors but didn't sound like that would be involved in this position. The queries are sent to the doctors via the computer system or email or text. They said the doctors are good with responding to the queries.

    So my drawback with the clin doc spec job is I hate public speaking. Maybe it's something i could get over., I don't know They say you use a template when preparing the presentation. The pay and benefit would be better at the hospital than the insurance company, though the insurance company still isn't bad. My last job was a work at home job at an insurance co as a case manager that I grew very isolated from being at home all the time. I would probably meet more people at the hosp job but maybe not since I'd just be holed up in the room with 4 other nurses all day long reviewing charts. The insurance company job would get me out 40% of the time.

    Does anyone do these jobs and could tell me which is more interesting and fulfilling? I would really like to do learn HEDIS as i've heard it opens alot of doors for future positions once learned and seems lots of places want HEDIS experience. But I'm sure learning coding would also be a valuable skill. Right now i come from a UR/CM background- have been doing that for the past 14 years.
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  3. by   ironica01
    I am currently working as a UR/CM in ED in a trauma hospital and it's busy. I see alot of posted jobs looking for HEDIS nurse what's the difference between the two?

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