Associate Clinical Documentation Improvement Specialist

University of Minnesota School of Nursing; Northern (KY); Hybrid; USD 60,000 - 107,000; Full time

Benefits offered by this job

Benefits package

Remote work option

Job summary

UnitedHealth Group seeks a Clinical Document Improvement Specialist to oversee CDI programs and implement CDI processes for inpatient records. The CDS ensures documentation explicitly identifies findings and conditions, improving coding accuracy and revenue integrity.

This remote, nationwide role supports Optum 360 CDI 3D technology usage and requires strong CDI credentials, with RN or medical graduate background and CCDS/CDIP as preferred qualifications.

Qualifications

• 2+ years acute care hospital RN experience OR Medical Graduate with CDI experience and CDI certification (CCDS, CDIP).
• Proficiency using a PC in a Windows environment (Word, Excel, PowerPoint) and Electronic Medical Records.

Responsibilities

• Perform concurrent and retrospective chart reviews to improve completeness of clinical documentation.
• Keep up to date with Medicare rules and ICD-10 coding trends.
• Investigate coding issues using ICD-10 materials and provide accurate results.
• Communicate with providers to obtain needed documentation specificity.
• Lead CDI improvements and articulate rationales for recommendations.
• Communicate documentation requirements across all provider levels.
• Ensure effective use of Optum CDI 3D Technology and approved forms.

Skills

RN experience

CDI experience

Education

BSN degree

Tools

Microsoft Word

Excel

PowerPoint

EMR

Job description

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

The Clinical Document Improvement Specialist (CDS) is responsible for providing CDI program oversight and day to day CDI implementation of processes related to the concurrent review of the clinical documentation in the inpatient medical record of Optum 360 clients' patients. The goal of the CDS oversight and practice is to assess the technical accuracy, specificity, and completeness of provider clinical documentation, and to ensure that the documentation explicitly identifies all clinical findings and conditions present at the time of service.

This position reviews all clinical information and documentation to make improvements that result in accurate, comprehensive documentation that reflects completely, the clinical treatment, decisions, and diagnoses for the patient. The CDS utilizes clinical expertise and clinical documentation improvement practices as well as facility specific tools for best practice and compliance with the mission/philosophy, standards, goals and core values of Optum 360. In this position the CDS will utilizing the Optum™ CDI 3D technology that is assisting hospitals to improve data quality to accurately reflect the quality of care provided and ensure revenue integrity.

Our three-dimensional approach to CDI technology, paired with best-practice adoption methodology and change management support, is helping hospitals make a real impact on CDI efficiency and effectiveness.

Key Outcomes

• Increase in identification of cases with CDI opportunities, with automated review of 100% of records
• Improved tracking, transparency and reporting related to CDI impact, revenue capture, trending, and compliance
• Easing the transition to ICD-10 by improving the specificity and completeness of clinical documentation, resulting in more accurate coding

This position does not have patient care duties, does not have direct patient interactions, and has no role relative to patient care.

You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office for a minimum of four days per week.

Work Location

Remote within the United States

Primary Responsibilities

• Perform concurrent and retrospective chart reviews for improving the overall completeness of clinical documentation
• Keep abreast of current coding trends and maintains up to date knowledge of Medicare rules and regulations regarding diagnosis coding and CDI current trends.
• Effectively utilizes ICD-10 and related materials to investigate coding issues and produce accurate results
• Conducts daily follow-up communication with providers regarding existing clarifications to obtain needed documentation specificity
• Provides expert level leadership for overall improvement in clinical documentation by providing proficient level review and assessment, and effectively articulating recommendations for improvement, and the rational for the recommendations
• Actively communicates with providers at all levels, to clarify information and to communicate documentation requirements for appropriate diagnoses based on severity of illness and risk of mortality
• Provides complete follow through on all requests for clarification or recommendations for improvement
• Ensures effective utilization of Optum® CDI 3D Technology to document all clarification activity
• Utilizes only the Optum360 approved clarification forms
• Proactively develops a reciprocal relationship with the HIM Coding Professionals
• Engages and consults with Physician Advisor /VPMA when needed, per the escalation process, to resolve provider issues regarding answering clarifications and participation in the clinical documentation improvement process

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• 2+ years acute care hospital clinical RN experience OR Medical Graduate with CDI experience and CDI certification (CCDS, CDIP)
• Intermediate level of proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point and Electronic Medical Records

Preferred Qualifications

• CCDS, CDIP or CCS certification
• Experience in Clinical Documentation Improvement
• BSN degree if a RN
• CAC experience (Computer Assistant Coding)
• Experience communicating & working closely with Physicians

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO, #GREEN