Clinical Documentation Improvement Specialist - Remote

Optum; Los Alamitos (CA); Remote; USD 73,000 - 130,000; Full time

Job summary

UnitedHealth Group is seeking a Clinical Documentation Improvement Specialist to work remotely within the United States. The role involves timely review of clinical records, ensuring evidence-based documentation, and collaboration with physicians to optimize coding accuracy and reimbursement.

Ideal candidates have nursing licensure or medical school background, CDI experience, familiarity with ICD-10-CM/PCS, and CCDS/CDIP/CCS credentials are a plus.

Qualifications

• Current RN license or Medical School Graduate.
• 3+ years acute inpatient CDI experience for RNs.
• 2+ years acute inpatient CDI experience for MDs.
• Experience communicating with physicians and performing concurrent chart reviews.

Responsibilities

• Review clinical records within 24-48 hours of admission for alignment with guidelines.
• Communicate with providers to reinforce evidence-based documentation.
• Track productivity and report leading indicators and analyses.
• Lead overall CDI improvements and provide actionable recommendations.
• Provide education for physicians and health care team members.
• Pivot with Care Coordination and Quality Management on improvement opportunities.
• Offer timely feedback on documentation opportunities and successes.
• Engage Medical Director/leadership to resolve clarifications as needed.

Skills

RN license

Medical school graduate

ICD-10-CM/PCS experience

Physician communication

Chart review processes

Query processes

Inpatient reimbursement knowledge

EMR proficiency

Education

CCDS/CDIP/CCS certifications

Tools

Microsoft Word

Excel

Electronic Medical Records

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Clinical Documentation Improvement Specialist - Remote (2393172)

Clinical Documentation Improvement Specialist - Remote - 2393172

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Jobs in this function provide coding and coding auditing services directly to providers. This includes the analysis and translation of medical and clinical diagnoses, procedures, injuries, or illnesses into designated numerical codes. *Employees in jobs labeled with ‘SCA’ must support a government Service Contract Act (SCA) agreement.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Provides expert level review of clinical records within 24-48 hours of admission; reviews clinical documentation to ensure consistency and alignment with evidence-based guidelines
• Conducts clear communication to providers to reinforce evidence-based guidelines are being followed
• Effectively tracks productivity to allow for accurate/timely reporting of leading indicators and future impact analyses
• 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 rationale for the recommendations
• Provides educational opportunities for physicians and other health care team members
• Provides complete follow through on all requests for clarification or recommendations for improvement
• Participates in the development and execution of education strategies resulting in improved clinical documentation
• Provides timely feedback to providers regarding clinical documentation opportunities for improvement and successes
• Engages and consults with Medical Director/leadership when needed, per the escalation process, to resolve issues regarding answering clarifications and participation in the clinical documentation improvement process
• Actively engages with Care Coordination and the Quality Management teams to continually evaluate and spearhead clinical documentation improvement opportunities
• Generally work is self-directed and not prescribed
• Works with less structured, more complex issues
• Serves as a resource to others

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:

• Current RN License or Medical School Graduate
• For RN: 3+ years acute inpatient CDI experience
• For Medical School Graduates: 2+ years of acute inpatient CDI experience
• Experience communicating & working closely with Physicians
• Experience performing concurrent inpatient chart reviews and physician query processes
• Experience working with ICD-10-CM/PCS documentation requirements
• Knowledge of inpatient reimbursement methodologies including MS-DRG and APR-DRG systems
• Knowledge of documentation regulations, compliant query practices, and coding guidelines
• Basic proficiency using a PC in a Windows environment, including Microsoft Word, Excel, and Electronic Medical Records

Preferred Qualifications:

• Current certification as a CCDS, CDIP or CCS
• Excellent verbal and written skills including solid organizational skills

*All employees working remotely 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 $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

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.