Clinical Documentation Improvement Expert

UnitedHealth Group; Glendale (CA); On-site; USD 73,000 - 130,000; Full time

Job summary

UnitedHealth Group in Glendale, CA is seeking a CDI Specialist to review inpatient records within 24-48 hours of admission, identify documentation gaps, and ensure diagnoses reflect severity of illness. You will lead physician education, coordinate with HIM Coding Professionals, Care Coordination, and use Optum CDI tools to drive accurate DRG assignments.

The ideal candidate will have associate degree, 5+ years acute care CDI or RN experience, strong clinical knowledge, and excellent

Qualifications

• Associate's degree required.
• 5+ years acute care hospital RN or CDI experience.
• Advanced knowledge in clinical medicine, pathophysiology and pharmacology.
• Strong communication with physicians.
• Proficient PC skills in Windows, Word, Excel, PowerPoint and EMR.

Responsibilities

• Review inpatient clinical records within 24-48 hours of admit and identify documentation gaps.
• Clarify documentation for accurate code assignment reflecting severity of illness.
• Conduct daily follow-up with providers to obtain needed documentation specificity.
• Lead physician education strategies to improve clinical documentation.
• Coordinate with HIM Coding Professionals and Care Coordination on DRG reconsolidation.
• Engage with Physician Advisor/VPMA to resolve provider issues.
• Utilize Optum CDI tools and forms for documentation clarification.

Skills

Clinical RN experience

CDI experience

Physician communication

PC literacy

Education

Associate's degree

BSN (RN) - preferred

CCDS/CDIP/CCS certification

CAC experience

Tools

EMR

Microsoft Word

Microsoft Excel

PowerPoint

Job description

UnitedHealth Group in Glendale, CA is seeking a CDI Specialist to review inpatient records within 24-48 hours of admission, identify documentation gaps, and ensure diagnoses reflect severity of illness. You will lead physician education, coordinate with HIM Coding Professionals, Care Coordination, and use Optum CDI tools to drive accurate DRG assignments.

The ideal candidate will have associate degree, 5+ years acute care CDI or RN experience, strong clinical knowledge, and excellent