UnitedHealth Group Inc.-posted 23 days ago
$58,800 - $105,000/Yr
Full-time • Entry Level
Remote • Bakersfield, CA
5,001-10,000 employees
Insurance Carriers and Related Activities

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 makes 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 - (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 reviews all clinical information and documentation 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 position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm - Monday - Friday. It may be necessary, given the business need, to work occasional overtime. We offer 4 weeks of on-the-job training. The hours of training will be aligned with your schedule. You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

  • Perform concurrent and retrospective chart reviews for improving the overall completeness of clinical documentation
  • Keep abreast of current coding trends and maintain up to date knowledge of Medicare rules and regulations regarding diagnosis coding and CDI current trends
  • Effectively utilizes ICD-10 and related materials to investigate coding issues and produce accurate results
  • 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
  • Provides complete follow-through on all requests for clarification or recommendations for improvement
  • Ensures effective utilization of Optum CDI 3D Technology to document all clarification activity
  • Utilizes only the Optum360 approved clarification forms
  • Proactively develops a reciprocal relationship with the HIM Coding Professionals
  • Engages and consultations 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
  • Associate degree (or higher)
  • Registered Nurse with 3+ years of clinical acute care hospital OR care coordination experience OR Medical Graduate with CDI (Clinical Documentation Integrity) experience
  • 2+ years of experience in clinical medicine, pathophysiology, and pharmacology
  • Intermediate level of proficiency using a PC in a Windows environment, including Microsoft Word, Microsoft Excel, Microsoft PowerPoint
  • Ability to work full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm - Monday - Friday. It may be necessary, given the business need, to work occasional overtime
  • Must be 18 years of age or older
  • BSN degree if a RN
  • 5+ years of acute inpatient hospital coding with certifications
  • 5+ years acute care hospital clinical RN experience OR Medical Graduate with CDI experience and CDI certification (CCDS, CDIP)
  • 3+ years of CDI experience for an acute care hospital
  • CAC experience (Computer Assistant Coding)
  • Grasp of ICD-10 coding, coding conventions, and guidelines
  • All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
  • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
  • Medical Plan options along with participation in a Health Spending Account or a Health Saving account
  • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
  • 401(k) Savings Plan, Employee Stock Purchase Plan
  • Education Reimbursement
  • Employee Discounts
  • Employee Assistance Program
  • Employee Referral Bonus Program
  • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
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