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Advice for RN wanting to get into CDI/UM/UR?

I am a nurse with 10 years of experience, most ER, with my BSN. I am currently working as a clinical coordinator in ER follow up at my local hospital, it’s a hybrid position, we assist people with follow up appointments so they don’t “fall through the cracks” or end up back in the ED, as well as URI, which follows all the labs upon discharge and looking for incidental findings in radiology reports. I am trying to get into utilization review or CDI right now, but is know CDI is tough with out experience in it so I’m doing my best and applying to all the UR/UM remote positions that I can find and transition to CDI. Also to applying to CDI positions that don’t ask for experience but I’m apply along with 100+ other people. Any recommendations of what education I can do to stand out for either position? I’m looking into education with AAPC that will lead to a basic certification or AHIMA boot camp, but they are pricey so I want to make the right choice and make sure it will actually boost my chances.

Thank you so much in advance!

healthcare clinical-documentation coding-utilizationreview-utilizationmanagment-cdi utilization-management
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Nikole’s Answer

With your medical coding background, I believe you're heading in the right direction. Your experience in the ER, your BSN, and your current job in coordinating follow-up care and reviewing discharge findings give you a solid clinical base for Utilization Review (UR) and can help you move into Clinical Documentation Improvement (CDI). Choosing AAPC is a smart move because it's well-known across the U.S., and many employers accept certifications from both AAPC and AHIMA. AHIMA is also a great option if you want a respected certification to boost your credentials. If you're looking for a certification to help you transition into inpatient CDI, AAPC's CIC might be more useful than CDEO. It focuses on inpatient coding, ICD-10-CM/PCS, MS-DRGs, documentation quality, and when you need to clarify with providers, which fits well with CDI work.
Thank you comment icon Thank you, this is amazing! I really needed it. Alina
Thank you comment icon You're welcome and I wish you the best. I know you can do it. Nikole Williams
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Michael’s Answer

Hello! I hope all is well! I have been working within the CDI space for approximately 2 years with Deloitte now, and it is a very exciting and rapidly growing space! My personal recommendation is to further familiarize yourself with the full revenue cycle process, from when the patient is originally booked for the appointment to when the insurance is billed. Specifically for caregivers, the most important thing is understanding CDI and coding guidelines, ensuring you are making an accurate and correct recommendation. For us at Deloitte, we work with healthcare facilities to ensure their patient records have the highest level of specificity, which in turns mean we have to accurately and properly QA our recommendations before sending queries to their physicians. I hope this helps!
Thank you comment icon Awesome! Thanks so much. Alina
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Ben’s Answer

Hi there! This is an exciting field with lots of tech growth, thanks to AI and large language models. If you're interested in this career, consider looking into EMR companies that are adding AI services. These services aim to reduce the need for utilization review and management but still require human oversight. A job where you learn about complex clinical documentation, use your nursing or medical knowledge, and understand hospital workflows will likely stay in high demand.

Coursera offers great programs from places like Duke Health or Johns Hopkins at an affordable price. EPIC EHR also has some CDI courses. You might want to talk to your hospital's IT leaders to see if they can help you connect with EMR/EHR resources and find free courses that offer certification.
Thank you comment icon Thank you, Ben! Alina
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