Clinical Documentation Integrity Specialist - Remote

UnitedHealth Group; United States; À distance; USD 60 000 - 107 000; Plein temps

Résumé du poste

Optum Insight, part of UnitedHealth Group, is transforming how health data flows to connect providers and payers, reducing costs while improving risk management and care quality. This remote, nationwide role focuses on clinical documentation improvement and collaboration with physicians, HIM teams, and coders to ensure accurate diagnoses and severity reflections.

You can work remotely from anywhere in the U.S.

Qualifications

• Must be a Medical Graduate (MD or MBBS).
• RN with an active, unrestricted US license and 5+ years of acute care hospital experience.
• Current CCDS, CDIP, or CCS Certification or able to obtain within 1 year or upon hire.
• 2+ years as a Clinical Documentation Improvement Specialist in an acute care setting.
• Advanced proficiency in clinical medicine, pathophysiology, and pharmacology.
• Proficient PC skills in Windows environment: Word, Excel, PowerPoint and EMRs.
• Ability to work Pacific Time Zone business hours (Mon-Fri) regardless of remote base.

Responsabilités

• Provides expert review of inpatient clinical records within 24-48 hours of admit to ensure accurate code assignment.
• Chats daily with providers to obtain needed documentation specificity.
• Leads overall improvement in clinical documentation with reasoned recommendations.
• Communicates with providers to clarify information and documentation requirements for diagnosis severity and mortality risk.
• Provides timely feedback on opportunities for documentation improvement.
• Utilizes CDI software to document all clarification activity.
• Collaborates with HIM Coding Professionals and consults Physician Advisor as needed.

Connaissances

Clinical documentation

Pathophysiology

Pharmacology

Windows PC

Formation

MD/MBBS

US RN license

CCDS/CDIP/CCS certification

BSN

Outils

Electronic Medical Records

Microsoft Word

Excel

PowerPoint

Description du poste

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 in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.

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 inpatient clinical records within 24-48 hours of admit; identifies gaps in clinical documentation that need clarification for accurate code assignment to ensure the documentation accurately reflects the severity of the condition and acuity of care provided
• 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 timely feedback to providers regarding clinical documentation opportunities for improvement and successes
• Ensures effective utilization of CDI software to document all verbal, written, electronic clarification activity
• 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:

• Must be one of the following to qualify:
  • A Medical Graduate (MD or MBBS)
  • Registered Nurse (RN) with an active, unrestricted RN License in the US and 5+ years of acute care hospital experience
• Current CCDS, CDIP, or CCS Certification OR willing/able to obtain within 1 year or hire
• 2+ years of experience working as a Clinical Documentation Improvement Specialist in an acute care hospital setting
• Advanced level of proficiency in clinical medicine, pathophysiology, and pharmacology
• Intermediate level of proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point and Electronic Medical Records
• Must be able to work Pacific Time Zone business hours (Monday - Friday) regardless of remote work base location/residency

Preferred Qualifications:

• BSN degree if a RN
• 3+ years of experience working in an acute care hospital
• CAC experience (Computer Assistant Coding)

Soft Skills:

• Experience communicating & working closely with Physicians

*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 $60,200 - $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 help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.

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