Clinical Documentation Specialist

4 weeks ago

Strathfield, Australia Ramsay Health Care Full time

**Clinical Documentation Specialist - Clinical Support**

**Strathfield Private Hospital, Strathfield**
- **Permanent part-time opportunities ****:

- We care about** YOU **Access counselling, **wellbeing services**, legal & financial assistance
- **Enjoy benefits** such as paid parental leave, study leave and the option to buy extra annual leave.

An exciting opportunity has become available for a Registered nurse to be trained as a Clinical Documentation Specialist, joining the established CDS Team working within Health Information Services.

**About the Role**
- **Your role**: Clinical Documentation Specialist
- **Mission**: Enhance clinical documentation quality in patient records
- **Autonomy**: Review current inpatients’ records independently post-training
- **Task**: Ensure documentation mirrors care complexity accurately
- **Communication**: Engage with medical staff on diagnosis and procedures
- **Collaboration**: Request clarifications in clinical notes for clear coding
- **Strategy**: Provide ongoing education to clinical team
- **Goals**: Improve documentation for enhanced quality, safety and revenue protection.

**About You**

**Dive into this role with at least 5 years of acute clinical experience and preferably bring along a post-graduate clinical qualification or leadership background**.
- **Your extensive clinical background is crucial, coupled with a solid grasp of clinical terminology and diagnosis.**:

- **Self-driven**: Be fueled by your own motivation, thriving both within team dynamics and independently.

You will also have the following:

- Current registration with AHPRA as a Registered Nurse
- Extensive experience in an acute care hospital setting
- Knowledge on related medical records documentation
- Demonstrated ability to develop and maintain good physician relationships
- Excellent critical thinking skills and attention to detail
- Proficient in the use of Microsoft Office suite of programs
- Some knowledge of the Clinical Documentation Specialist role and the confidence to liaise with medical staff on patient treatment/outcomes is essential
- The successful applicant needs to have extensive experience in a number of hospital areas with ED and ICU/CCU specialties desirable.

**What’s in it for you?**

**Professional Advancement**: Recognition, Rewards, Professional Development, and Employee referral programs. Free access to LinkedIn Learning, education scholarships and the Ramsay Leadership Academy to support career progression.

**Discounts**: Ramsay Rewards - Access great deals at major retailers. Hospital, Allied Health & Pharmacy discounts - you’ll pay less for hospital cover and receive higher extras limits for things like General and Major Dental.

**Health and Wellbeing**: Flexible work opportunities with the ability to have a say in your roster, Flexible Leave Program, and a free Employee Assistance Program offering access to confidential counselling, coaching and support 24/7.

**Leisure/Social/Financial**: Discounts for leisure travel with selected Hotels, salary sacrifice opportunities e.g., airport lounge membership, self-education expenses, novated leasing and more.

**About Ramsay**

Strathfield Private Hospital has been servicing the community of Sydney’s inner west for over 30 years and is owned by global hospital group Ramsay Health Care. We cater for a broad range of health care needs from day surgery procedures to highly complex surgery.

**Requirements**:

- _Must provide a _**National Police** check conducted within the previous 12 months
- Depending on the role, Ramsay may require a **Working-With-Children** check and **proof of immunisation** against infectious diseases, which may include Covid-19.

**To Apply

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