Clinical Documentation Integrity (CDI) Specialist

UnitedHealth Group • Redding, CA

1d • Remote

About The Position

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.
The Clinical Documentation Integrity (CDI) Specialist is responsible for reviewing clinical documentation to ensure accuracy, completeness, and compliance with regulatory and coding requirements. This role collaborates with providers, coding, quality, and revenue cycle teams to support accurate severity of illness (SOI), risk of mortality (ROM), quality metrics, and reimbursement.
This position is fully remote and requires strong clinical expertise, excellent communication skills, and a solid understanding of compliance and documentation standards.
You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
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.

Requirements

• Active RN, MD, DO, or International Medical Graduate (IMG) license/credential (as applicable)
• 2+ years of recent clinical and/or acute care experience
• 1+ years CDI experience
• Advanced knowledge of: ICD 10 CM diagnosis coding
• MS DRGs and/or APR DRGs
• SOI/ROM, CMI, and quality indicators
• Familiarity with EHR systems (Cerner)
• Knowledge of AHIMA/ACDIS compliant query practices

Nice To Haves

• CDI certification: CCDS (Certified Clinical Documentation Specialist)
• CDIP (Certified Documentation Improvement Practitioner)
• Experience with: Risk adjustment (HCCs)
• Medicare Advantage or value based care models
• Payer based or vendor CDI programs
• Prior remote CDI experience
• Inpatient CDI experience
• Proficiency in Microsoft Office, CDI software, and other EHR platforms
• Skills & Competencies: Excellent written and verbal communication
• Solid clinical judgment and analytical skills
• Time management and ability to meet productivity targets in a remote environment

Responsibilities

• Clinical Documentation Review: Conduct concurrent and/or retrospective reviews of inpatient and/or outpatient medical records
• Identify documentation gaps, inconsistencies, or clinical indicators requiring clarification
• Ensure documentation supports accurate ICD 10 CM/PCS coding, DRG assignment, and risk adjustment
• Provider Queries & Communication: Initiate compliant, concise provider queries in accordance with AHIMA/ACDIS guidelines
• Educate providers on documentation best practices to improve clarity and specificity
• Serve as a clinical resource for documentation improvement initiatives
• Quality & Compliance: Support quality reporting measures (e.g., HCCs, PSI, HAC, mortality metrics)
• Ensure compliance with federal and state regulations, payer requirements, and internal policies
• Maintain audit ready documentation practices
• Collaboration & Reporting: Collaborate with coding, case management, utilization review, finance, and quality teams
• Track CDI metrics such as query response rates, case mix index (CMI), and documentation impact
• Participate in team meetings, audits, and continuous process improvement efforts

Benefits

• In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees