Manager, Clinical Documentation Integrity - Telecommute

UnitedHealth Group•Santa Maria, CA

16h•$91,700 - $163,700•Remote

About The Position

The Manager, Clinical Documentation Integrity provides oversight of the CDI program and day-to-day implementation of processes for concurrent review of inpatient medical records for Optum 360 clients. The role supports the CDI manager function through staff oversight, serving as an additional resource, and performing CDI duties. It assesses and teaches staff and providers to improve the technical accuracy, specificity, and completeness of documentation so records identify the clinical findings and conditions present at the time of service. The Manager collaborates with the CDI Director, providers, and other healthcare team members to improve documentation that accurately reflects patient treatment, clinical decisions, and diagnoses. The role uses clinical expertise, CDI practices, and facility-specific tools to support best practices and compliance with Optum 360 standards and values. It has no patient care duties or direct patient interactions. The position is remote within the United States, with required travel to client locations, approximately 30–40%.

Requirements

At least 3 years of acute care hospital clinical RN experience, or medical graduate status with CDI experience and CDI certification (CCDS or CDIP).
At least 2 years of experience communicating and presenting to physicians.
Proficiency with a PC in a Windows environment, including Microsoft Word, Excel, PowerPoint, and electronic medical records.
Ability to travel 30–40% to client sites.
Remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.
Must pass a drug test before beginning employment.

Nice To Haves

CCDS, CDIP, or CCS certification.
People management experience.
Experience in Clinical Documentation Improvement.
CAC (Computer Assisted Coding) experience.

Responsibilities

Conduct chart, quality, and KPI audits.
Run reports and attend on-site meetings as directed.
Oversee CDI staff training, orientation, and workflows.
Develop physician teaching and on-site presentations.
Assist the CDI Director with projects and tasks as needed.
Approve timecards, coach staff, and conduct evaluations.
Communicate leadership performance expectations to CDI staff.
Oversee expert review of inpatient clinical records within 24–48 hours of admission and identify documentation gaps requiring clarification for accurate code assignment and reflection of patient severity and acuity of care.
Ensure daily follow-up communication with providers regarding outstanding clarifications and needed documentation.
Provide leadership for clinical documentation improvement through proficient review and assessment, recommendations, and explanation of their rationale.
Communicate with providers at all levels to clarify information and explain documentation requirements for diagnoses based on severity of illness and risk of mortality.
Conduct regular rounding with unit-based physicians and provide face-to-face physician education.
Follow through on clarification requests and recommendations for improvement.
Lead development and execution of physician education strategies to improve clinical documentation.
Provide timely feedback to providers on documentation improvement opportunities and successes.
Ensure effective use of the CAC tool and documentation of verbal, written, and electronic clarification activity.
Use Optum360-approved paper or electronic forms.
Develop reciprocal working relationships with HIM Coding Professionals and coordinate regular meetings to monitor retrospective query rates and address issues.
Engage and consult the Physician Advisor, as needed under the escalation process, to resolve provider issues concerning clarifications and participation in CDI.
Engage with Care Coordination and Quality Management teams.
Use enterprise-approved AI tools to streamline workflows, automate tasks, and drive continuous improvement.
Evaluate emerging trends to inform solution design and strategic innovation.
Perform other duties as assigned.