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Clinical Documentation Improvement Specialist - United Health Group

Requisition Number: 885299

Career Area: Clinical

Location: Sacramento, CA


Clinical Compassion. It’s the starting point for health care providers like you and it’s what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you’re also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life’s best work.SM

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life’s best work.(sm) The Clinical Document Improvement Specialist – (CDS) 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 CDS oversight and practice 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 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. In this position the CDS will utilizing 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.

  • Increase in identification of cases with CDI opportunities, with automated review of 100% of records

  • Improved tracking, transparency and reporting related to CDI impact, revenue capture, trending and compliance

  • Easing 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. This is an onsite position at Methodist Hospital in Sacramento, CA Monday-Friday – Days Primary Responsibilities:

  • Provides 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 condition and acuity of care provided

  • Conducts daily follow-up communication with providers regarding existing clarifications to obtain needed documentation specificity

  • 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 and provides Working DRG lists to Care Coordination

  • Provides face-to-face educational opportunities with physicians on a daily basis

  • 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

  • Provides timely feedback to providers regarding clinical documentation opportunities for improvement and successes

  • Ensures effective utilization of Midas or Optum® CDI 3D Technology to document all verbal, written, electronic clarification activity

  • Utilizes only the Optum360 approved clarification forms

  • Proactively develops a reciprocal relationship with the HIM Coding Professionals

  • Coordinates and conducts regular meeting with HIM Coding Professionals to reconcile DRGs, monitor retrospective query rates and discuss questions related to Coding and CDI

  • Engages and consults 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 engages with Care Coordination and the Quality Management teams to continually evaluate and spearhead clinical documentation improvement opportunities

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:

  • 5+ years of acute care hospital clinical RN experience OR Medical Graduate with 1 of year CDI experience

  • Proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point and Electronic Medical Records

  • Experience communicating & working closely with Physicians

Preferred Qualifications:

  • CCDS, CDIP or CCS certification

  • BSN degree, if a RN

  • CAC experience (Computer Assistant Coding)

  • Currently a Clinical Documentation Improvement specialist with at least 1 year of experience conducting reviews, sending queries and educating physicians

Careers with Optum. Here’s the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work.(sm) 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. Job Keywords: RN, Registered Nurse, CCDS, Certified Clinical Documentation Specialist, CDIP, Clinical Documentation Improvement Professional, CCS, Certified Coding Specialist, Doctor, Physician, CDI, Methodist Hospital, Sacramento, CA, California



https://careers.unitedhealthgroup.com/job/11775170/clinical-documentation-improvement-specialist-5k-sign-on-sacramento-ca-sacramento-ca/



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