Clinical Documentation Improvement Specialist

1 day ago


Bettendorf, Iowa, United States Optum Full time
Job Summary

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. Come make an impact on the communities we serve as you help us advance health equity on a global scale.

Job Responsibilities
  • 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.
Requirements
  • 5+ Years of Acute Care Hospital Clinical RN Experience OR Medical Graduate with CDI experience and CDI certification (CCDS, CDIP).
  • Experience Communicating & Working Closely with Physicians (this is a patient and Physician facing role).
  • Proficiency Using a PC in a Windows Environment, including Microsoft Word, Excel, Power Point and Electronic Medical Records.
  • Live in the Arroyo Grande CA Regional Area (this position is onsite and not eligible for remote work).
  • Willing or Ability to Work Onsite at a Hospital Location in Arroyo Grande CA full time (Monday - Friday) in a daily patient and Physician facing capacity.


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