Route to CDI for experienced nurse w/no acute inpatient experience?

[ivyleaf]

So, the more I have read about CDI, the more I think it would be a great fit for my interests/personality. I love investigating and classifying things, am good at finding flaws/errors (esp. in others' documentation), love auditing records, and enjoy writing and precision with words (my MBTI personality type is INTP).

My experience is all in psychiatry and outpatient (mostly primary care, some rheumatology and urgent care-- I was a float), both case management and direct care-- and I haven't seen any postings for this sort of position in these areas (Inpatient psychiatry or outpatient/primary/ambulatory care).

If I was able to get a position in acute inpatient utilization review w/an insurance company, what are the odds of getting hired into CDI from there (with 2-3 yrs experience and a coding course)? After leaving a float position in ambulatory care, I have spent the last year in a mental health agency as a case manager supervisor/team lead. We work with a behavioral health population, but we do "medical" case management as well, follow up on medical hospitalizations & ED visits, health coaching/teaching, coordinating w other medical providers, etc. I am looking to move away from behavioral health, but enjoy the theory/pathophys/reading about medicine/nursing much more than actual hands-on patient care.

I have been a nurse for over 10 yrs and haven't worked full time in the hospital for 4 years; the idea of going back and learning a new specialty from the ground up, along w/working every other weekend, is not appealing.

Any thoughts about possible next steps?

[Sand_Dollar, BSN]

Hi ivyleaf,

I am currently a CDI in a level 2 trauma hospital. I have been looking at other positions and haven't found one that doesn't require at least 1 year of acute care nursing. The big hospitals want you to have at least 3 years in an ICU or ER for background.

It's not just coding, which in itself is a challenge, but the clinical part of it. I had a patient who was found down and had a STEMI. They were so focused on the STEMI they overlooked the very high CK-MB. I sent a query for Rhabdo which the physician agreed with. Without the clinical experience you won't know what to look for in critically ill patients.

CDI is horribly hard to get into even with the preferred clinical background, most jobs want experience. It took me months to find a job and when I did I took a pay cut and now commute an hour each way just because they were willing to train someone. I have never heard of anyone going from UR to CDI, but every hospital is different and one may accept that as background.

I wish you luck! I adore CDI; it's everything I love about ICU (critical thinking, multiple co-morbidities and putting the puzzle pieces together), but it's a ton less stress than ICU. My back is still intact, my knees don't hurt and when a code blue is called I just put my headphones back in and get back to reading through another chart.

[SKM-NURSIEPOOH, BSN, RN]

On 9/23/2019 at 11:03 PM, ivyleaf said:

So, the more I have read about CDI, the more I think it would be a great fit for my interests/personality. I love investigating and classifying things, am good at finding flaws/errors (esp. in others' documentation), love auditing records, and enjoy writing and precision with words (my MBTI personality type is INTP).

My experience is all in psychiatry and outpatient (mostly primary care, some rheumatology and urgent care-- I was a float), both case management and direct care-- and I haven't seen any postings for this sort of position in these areas (Inpatient psychiatry or outpatient/primary/ambulatory care).

If I was able to get a position in acute inpatient utilization review w/an insurance company, what are the odds of getting hired into CDI from there (with 2-3 yrs experience and a coding course)? After leaving a float position in ambulatory care, I have spent the last year in a mental health agency as a case manager supervisor/team lead. We work with a behavioral health population, but we do "medical" case management as well, follow up on medical hospitalizations & ED visits, health coaching/teaching, coordinating w other medical providers, etc. I am looking to move away from behavioral health, but enjoy the theory/pathophys/reading about medicine/nursing much more than actual hands-on patient care.

I have been a nurse for over 10 yrs and haven't worked full time in the hospital for 4 years; the idea of going back and learning a new specialty from the ground up, along w/working every other weekend, is not appealing.

Any thoughts about possible next steps?

Since you have UR and outpatient nursing experience, you might consider outpatient CDI which is hot right now. You are familiar with E/M process as a psych nurse, UR, and documentation. You can check-out the ACDIS website as they've just developed the CCDS-O certification for outpatient CDI.

Some insurance companies utilize the UR nurses for both concurrent and retrospective audits and look to them to also do clinical validation reviews as well as CDI specialists (which is more needed in CDI as sometimes queries are asked inappropriately because conditions are uncovered incidentally but have no clinical significance or barring on the inpatient stay as there's no follow-up evaluation, monitoring, or treatment).

I've seen CDI fall under the HIM and/or UR department umbrellas so it all depend on the hospital or consulting firm to determine the qualifications for inpatient and outpatient CDI. The insurance company and RAC auditor companies will train UR nurses for CDI or RAC audit reviews as these require clinical validation.

Good luck in your quest in the CDI arena.

Cheers!

Moe