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Clinical Documentation Improvement Specialist Chandler AZ

Company: UnitedHealth Group
Location: Glendale
Posted on: September 17, 2023

Job Description:

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.--

The Clinical Document Improvement Specialist - (CDIS) 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 Optum360 clients' patients. The goal of the CDIS 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 CDIS 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 Optum360. In this position the CDIS 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 such as an increase in identification of cases with CDI opportunities, with automated review of 100% of records and improved tracking, transparency and reporting related to CDI impact, revenue capture, trending and compliance.

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

Monday - Friday, days
Weekend coverage as needed
Primary Responsibilities:

  • Provide--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
  • Conduct--daily follow-up communication with providers regarding existing clarifications to obtain needed documentation specificity
  • Review--ED and Rehab department documentation and provides education to the physicians as needed
  • 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, and quality metrics
  • Perform regular rounding with unit-based physicians and provides Working DRG lists to Care Coordination
  • Provide face-to-face educational opportunities with physicians on a daily basis
  • Provides 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 Midas and Optum-- CDI 3D Technology to document all verbal, written, electronic clarification activity
  • Utilize only the Optum360 approved clarification forms
  • Proactively develop a reciprocal relationship with the HIM Coding Professionals
  • Coordinate--and conduct regular meeting 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 /CMO/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--

    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:

    • Current, unrestricted RN License or Medical Graduate with CDI experience
    • 2+ years of acute care hospital clinical experience
    • Experience communicating & working closely with Physicians
    • Must have proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point and Electronic Medical Records

      Preferred Qualifications:
      • BSN degree
      • CCDS, CDIP or CCS certification
      • Experience in Clinical Documentation Improvement
      • Case Management experience
      • Cerner, Meditech or other EMR experience
      • CAC experience (Computer Assistant Coding)
      • Coding knowledge and experience
      • Clinical knowledge and experience working in a Trauma unit
      • Proficiency in ICD-10 coding classification, DRG and reimbursement methodology
      • Proven excellent communication skills

        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.--

Keywords: UnitedHealth Group, Glendale , Clinical Documentation Improvement Specialist Chandler AZ, Healthcare , Glendale, Arizona

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