Clinical Documentation Improvement Specialist


Clinical Documentation

West Islip
1000 Montauk Highway West Islip, NY 11795

Full Time

Day shift

8a-4p or 7a-3p

Clinical Documentation Specialist 

Good Samaritan Hospital Medical Center is a 537- bed (including 100 nursing home beds) teaching hospital and a member of Catholic Health Services of Long Island. With almost 900 physicians on staff, and a level II Trauma Center, we care for well over 100,000 patients annually across the south shore of Long Island. Our reputation for excellence is built on great choices and empowered leadership, and fosters a team that's focused on evidence based practice, continual learning and exceptional quality of care.

The clinical documentation specialist is responsible for improving the overall quality and completeness of clinical documentation within the inpatient record.


·        Performs concurrent reviews, facilitates modifications to the clinical documentation to accurately reflect the severity of illness and risk of mortality through extensive interaction with physicians, coding and other health care professionals

·        Serves as a resource to improve capture and accuracy of the final coded DRG; able to meet daily production expectations, while impacting on the integrity of the in-patient record.  This position requires attention to detail and is production based

·        Educate health care professionals in various settings



·        Registered Nurse, Nurse Practitioner, Physician Assistant or MD licensed to practice in the State of New York required.

·        Must have strong current clinical knowledge and be able to collaborate with healthcare professionals in an efficient effective professional manner

·        Minimum of 5 years recent staff nurse clinical acute care in-patient experience required. 

·        Critical care experience preferred.

·        Candidate needs to be self-motivated, self-directed, and able to work independently with minimal supervision.

·        Must be able to read, understand and apply coding guidelines (after training). Must have excellent communication skills, both verbal and written

·        Proficient in Microsoft Word, Excel, Windows and Power Point


At Catholic Health Services of Long Island your well-being comes first, with comprehensive compensation and benefits; our offerings go beyond the basics. In addition to multiple medical plans, life insurance, generous paid time off and flexible spending accounts, we also offer substantial tuition reimbursement, an employer funded pension plan and several savings plan options for your future.