Clinical Documentation Improvement Specialist

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Our mission is to help people live healthier lives and make the health system work better for everyone.

The Clinical Documentation Improvement Specialist 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 the CDI specialist is to assess 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 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 CDI specialist 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.

In this position, the CDI specialist will utilize the Optum CDI 3D technology that is assisting hospitals to improve data quality to accurately reflect the quality of care provided and ensure revenue integrity. Our three-dimensional approach to CDI technology, paired with best-practice adoption methodology and change management support, is helping hospitals make a real impact on CDI efficiency and effectiveness.

• Identify cases with CDI opportunities, with automated review of 100% of records
• Improve tracking, transparency, and reporting related to CDI impact, revenue capture, trending, and compliance
• Ease the transition to ICD-10 by improving the specificity and completeness of clinical documentation, resulting in more accurate coding

This position does not have patient care duties, does not have direct patient interactions, and has no role relative to patient care.

Work Location: onsite at client hospital

• Provide expert-level review of inpatient clinical records within 24-48 hours of admit; identify 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
• Conduct daily follow-up communication with providers regarding existing clarifications to obtain needed documentation specificity
• Provide 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 communicate 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
• Perform regular rounding with unit-based physicians and provide Working DRG lists to Care Coordination
• Provide face-to-face educational opportunities with physicians on a regular basis
• Provide complete follow-through on all requests for clarification or recommendations for improvement
• Lead the development and execution of physician education strategies resulting in improved clinical documentation
• Provide timely feedback to providers regarding clinical documentation opportunities for improvement and successes
• Ensure effective utilization of Optum CDI 3D Technology to document all clarification activity
• Utilize only the Optum360 approved clarification forms
• Proactively develop a reciprocal relationship with the HIM Coding Professionals
• Coordinate and conduct regular meetings with HIM Coding Professionals to reconsolidate DRGs, monitor retrospective query rates, and discuss questions related to Coding and CDI
• Engage and consult 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
• Actively engage with Care Coordination and the Quality Management teams to continually evaluate and spearhead clinical documentation improvement opportunities

• 5+ years of acute care hospital clinical RN experience OR Medical Graduate with CDI experience and CDI certification (CCDS, CDIP)
• Experience communicating and working closely with Physicians (this is a patient and Physician-facing role)
• Proficiency using a PC in a Windows environment, including Microsoft Word, Excel, PowerPoint, and Electronic Medical Records
• Live in the Arroyo Grande CA regional area (this position is onsite and not eligible for remote work)
• Willing or able to work onsite at a hospital location in Arroyo Grande CA full-time (Monday-Friday) in a daily patient and Physician-facing capacity

• BSN degree if a RN
• CCDS, CDIP, or CCS certification
• Experience in Clinical Documentation Improvement
• CAC experience (Computer-Assisted Coding)

California Residents Only: The salary range for this role is $70,200 to $137,800 annually. Pay is based on several factors, including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

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.

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.