Optum | Director and Clinical Subject Matter Expert, Clinical Documentation Integrity

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. Join us to start 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:

The Director and Clinical Subject Matter Expert, Clinical Documentation Integrity in Optum Advisory, Finance & Operations serves as a clinical subject matter expert for engagements with healthcare provider clients across a range of projects, primarily focused on acute care clinical documentation integrity and provider engagement and education in clinical documentation. Additional clinical revenue cycle projects may focus across ambulatory clinical documentation integrity, coding optimization (profee, outpatient, and inpatient), CDI programmatic optimization and/or design and launch, and coding and CDI organizational structure redesign, optimization, and centralization. While not a principal focus of this role, project efforts may require collaboration with key teams typically outside of the revenue cycle, such as care management, utilization review, population health, and other key areas as needed. Key responsibilities of the Director and Clinical SME, CDI role will include: 

• Serves as clinical subject matter expert for clinical engagements, with emphasis on clinical documentation integrity (acute care is the primary focus)
• Demonstrates sufficient executive presence to lead onsite presentations, including key client executive leadership sessions and provider education sessions (group and individual)
• Assists consulting team in accurately diagnosing client clinical revenue cycle improvement opportunities and issues and determines the appropriate solutions that will lead the client to achieve best practice
• Identifies needed data/information for the engagement and provides subject matter expertise as need in conducting  appropriate analyses (e.g., CMI analytics, provider outlier analytics, CC/MCC analytics, HCC analytics)
• Prepares customized client recommendations to realize improvement opportunities identified based on industry best practices and emerging ‘best-in-class’ approaches and facilitates implementation of recommendations
• Supports presentation of clinical engagement deliverables to applicable stakeholders (e.g. diagnostic findings and recommendations, chart review findings, clinical documentation integrity improvement opportunities)
• Conducts clinical analytics, such as professional, outpatient, and/or inpatient chart reviews and/or oversees chart review efforts conducted by third-party partners, providing guidance and quality assurance 
• Builds consensus among client stakeholders who play a critical key role in the health system’s ability to successfully implement the recommended strategies and tactics
• Communicates effectively and accurately in writing and verbally to prospects, members and other staff
• Demonstrates solid relationship management skills and ability to handle challenging interpersonal situations
• Cultivates the client's perception of Optum as a trusted partner and strategic advisor (e.g., build credibility, demonstrate full understanding of their business, leverage other resources within OptumInsight)
• Drives high levels of client satisfaction by driving results that meet or exceed the client's expectations
• Ensures engagement quality through running to criticism with both team members and clients alike, regularly seeking proactive feedback and adjusting course as needed based on feedback provided 
• Applies knowledge of change management principles to drive implementation of engagement objectives
• Leverages project documents and deliverables to provide re-use/transferability for other engagements (e.g., de-identifying content, cataloguing deliverables, storing documents in appropriate shared folders)
• Identifies lessons learned and communicate to appropriate stakeholders across both internal team and client, as appropriate
• Provides subject matter expertise to contribute to new product development (e.g., development of ambulatory CDI program) as well as the enhancement of existing solutions 
• Leverages and contributes to the applicable knowledge repositories (e.g., Microsoft Teams, SharePoint, analysis tools, project toolkits)
• Contributes to practice-level initiatives, including business development and thought leadership, beyond client project work, including preparation for and participation in clinical revenue cycle business development meetings, demonstration of solutions, and overall pipeline development / strategy
• Serves as a clinical subject matter expert for business development activities, participating in internal and client facing meetings as needed
• Stays current on important issues in the healthcare industry and maintains active participation in relevant professional organizations (e.g. ACDIS, AHIMA), sharing key trends and lessons learned back with broader team
• Shares professional and domain knowledge with peers and colleagues to build overall organization capabilities and expertise

The successful candidate will possess the following characteristics:

• Ability to effectively engage, educate and present to clinicians and physicians around documentation concepts 
• Knowledge of ICD-10-CM / PCS, CPT, HCPCS, HCC, and modifier coding and specificity of documentation changes
• Ability to work as part of team, meet deliverable deadlines, and collaborate with clinical and non-clinical team members
• Ability to drill down to the root cause of client challenges and deploy creative problem solving to drive client results
• Exceptional written and verbal communication skills
• Proven ability to drive quantifiable results 
• Ability to work independently with minimal supervision
• Solid critical thinking, relationship building, and time management skills
• Proficient in Microsoft suite, including Outlook, Excel, Word, and PowerPoint

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:

• U.S. Registered Nurse (RN) 
• Certified Clinical Documentation Specialist (CCDS) credential 
• 5+ years of clinical documentation integrity focused experience within a healthcare provider setting or a professional services (consulting) capacity 
• 5+ years of subject matter knowledge of clinical documentation, with deep experience across acute care required (and some familiarity with ambulatory care setting preferred but not required)
• 5+ years of experience facilitating the exchange and delivery of information within all levels in a provider based, client organization, including, but not limited to: surgeons, anesthesiologists, hospital executives, and other professional and ancillary staff
• Willingness to travel to client onsites as needed (up to 70%)

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $122,100 to $234,700 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 401k 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.  

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 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.