Manager, Clinical Documentation Integrity - Telecommute

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.

The Clinical Document Improvement Specialist Manager - 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 LCDS oversight and practice is to support the CDI manager function by providing staff oversite, serve as an additional resource as well as perform CDI role function. The Manager will assure via assessment, and teaching staff and providers 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 collaborates with CDI Director, providers and other healthcare team members 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. This position does not have patient care duties, does not have direct patient interactions, and has no role relative to patient care.

*** Travel is required to client locations**

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

Primary Responsibilities:  

• Conducts chart audits, quality audit and KPI audits
• Conducts CDI Manager with running reports, attends on site meetings as directed
• Oversees CDI staff training and orientation
• Overseas and leads workflow for CDI staff
• Develops physician teaching and on-site presentations
• Assist CDI Director with projects or tasks as needed
• Timecard approval
• Coaching
• Evaluations
• Other duties as assigned
• Communicates performance expectation of leadership to staff level CDI staff
• Oversee that CDI staff are providing 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 patient condition and acuity of care provided
• Ensures and oversee daily follow-up communication with providers regarding existing clarifications to obtain needed documentation specifically
• 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
• Performs regular rounding with unit-based physicians
• Provides face-to-face educational opportunities with physicians.
• Provides complete follow-through on all requests for clarification or recommendations for improvement
• Leads the development and execution of physician education strategies resulting in improved clinical documentation
• Ensures timely feedback to providers regarding clinical documentation opportunities for improvement and successes
• Ensures effective utilization of the CAC tool, ensuring documentation of all verbal, written, electronic clarification activity
• Utilizes only the Optum360 approved forms, whether paper or electronic
• Proactively develops a reciprocal relationship with the HIM Coding Professionals
• Coordinate and conduct regular meetings with HIM Coding Professionals to monitor retrospective query rate and address issues
• Engages and consults with Physician Advisor when needed, per the escalation process, to resolve provider issues regarding answering clarifications and participation in the clinical documentation improvement process
• Actively engages with Care Coordination and the Quality Management teams
• Use enterprise-approved AI tools to streamline workflows, automate tasks, and drive continuous improvement 
• Evaluate emerging trends to inform solution design and strategic innovation

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: 

• 3+ years of acute care hospital clinical RN experience OR Medical Graduate with CDI experience and CDI certification (CCDS, CDIP)
• 2+ years of experience communicating & presenting to Physicians
• Proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point and Electronic Medical Records
• Ability to travel 30-40%25 to client sites

Preferred Qualifications: 

• CCDS, CDIP or CCS certification
• People management experience
• Experience in Clinical Documentation Improvement
• CAC experience (Computer Assistant Coding)

*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 $91,700 - $163,700 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 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.