Senior Clinical Documentation Improvement Strategist

Jobtome; Maywood (WV); On-site; USD 73,000 - 130,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase plan

401k contribution

Job summary

Optum, part of UnitedHealth Group, seeks an experienced CDI RN to review inpatient records within 24-48 hours of admission and identify documentation gaps for accurate coding. You will actively communicate with physicians to obtain specificity and lead education efforts in clinical documentation improvement.

The role involves coordinating with HIM Coding, rounding with physicians, and driving CDI activities with Care Coordination and Quality Management teams to enhance documentation quality and

Qualifications

• Associate's degree required; RN with acute care experience accepted
• 5+ years of acute care hospital clinical RN experience or CDI experience for Medical Graduates
• Advanced proficiency in clinical medicine, pathophysiology, and pharmacology
• Strong communication skills with physicians and care teams
• Proficiency using Windows PCs, MS Word/Excel/PP and EMR systems

Responsibilities

• Review inpatient clinical records within 24-48 hours of admit
• Identify gaps in documentation for accurate code assignment
• Communicate with providers to obtain documentation specificity
• Lead physician education on clinical documentation improvement
• Collaborate with HIM Coding in DRG reconsolidation and CDI activities
• Support Care Coordination and Quality Management teams in improvement initiatives

Skills

Acute care nursing

Clinical documentation

Physician communication

EMR proficiency

CDI experience

Education

Associate's degree

BSN preferred

CDI certifications (CCDS/CDIP/CCS) preferred

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Electronic Medical Records

Job description

Optum, part of UnitedHealth Group, seeks an experienced CDI RN to review inpatient records within 24-48 hours of admission and identify documentation gaps for accurate coding. You will actively communicate with physicians to obtain specificity and lead education efforts in clinical documentation improvement.

The role involves coordinating with HIM Coding, rounding with physicians, and driving CDI activities with Care Coordination and Quality Management teams to enhance documentation quality and