RN Supervisor, CDI Team

UnitedHealth Group•Worcester, MA

12h•$72,800 - $130,000

About The Position

The Supervisor, Clinical Documentation Improvement & Risk Adjustment is a working supervisor responsible for coordinating and supervising the day-to-day operations of the Risk Adjustment/Clinical Documentation Improvement RN team while also participating in clinical documentation and medical record reviews. The role sets priorities, assigns and coordinates work, monitors workflow and performance, provides clinical and operational guidance, and supports staff development to ensure timely, accurate, and consistent work. The Supervisor performs prospective, concurrent, and retrospective reviews of medical records and available claims information to support the complete and accurate capture of documented chronic conditions under HCC and other applicable risk adjustment models. Reviews assess clinical support and consistency with established documentation, coding, and organizational guidelines, and may identify opportunities ahead of upcoming patient visits. The role works with Risk Adjustment leadership, clinicians, Coding, Analytics, and other operational partners to support quality assurance, workflow consistency, provider education, staff development, and Optum Massachusetts risk adjustment initiatives. Direct supervisory duties include work assignment, scheduling and coverage, productivity and quality monitoring, chart audits, coaching, performance feedback, training, and participation in hiring.

Requirements

Undergraduate degree in Nursing, or equivalent education and experience consistent with organizational requirements.
Current, unrestricted Registered Nurse (RN) license in the applicable state.
If CRC certification is not held at hire, it must be obtained within one year of employment.
At least 3 years of clinical experience.
At least 3 years of clinical experience working with chronic disease populations in an ambulatory and/or inpatient setting.
Solid clinical knowledge of chronic disease populations.
Knowledge of clinical documentation integrity and risk adjustment principles.
Working knowledge of HCC models and applicable CMS requirements.
Working knowledge of ICD-10-CM coding principles.
Medical record review and clinical validation skills.
Ability to conduct quality audits and provide constructive feedback.
Analytical and problem-solving skills.
Ability to prioritize and coordinate a clinical team's work while maintaining hands-on responsibilities.
Written and verbal communication skills.
Ability to coach and develop staff and collaborate with clinicians, coding, analytics, operations, and leadership.
Electronic health record navigation skills.
Proficiency with Microsoft Office applications, including Excel.

Nice To Haves

Professional coding certification, such as CRC through AAPC.
Experience across multiple specialties and disease states.
Experience with clinical documentation, risk adjustment, medical record review, HCC programs, clinical auditing, or coding.
Previous supervisory, team lead, or demonstrated leadership experience.

Responsibilities

Supervise and coordinate the day-to-day activities of the Risk Adjustment/Clinical Documentation Improvement RN team while maintaining hands-on clinical and operational responsibilities.
Set daily priorities, assign and coordinate work, monitor workloads, and adjust assignments based on operational priorities, patient volumes, upcoming appointments, and staffing needs.
Coordinate staff scheduling and coverage to support continuity of daily operations.
Provide day-to-day clinical and operational guidance, resolve operational issues, and coordinate work with supervisors, leaders, and operational partners.
Develop short-term plans to support department priorities and objectives.
Perform prospective, concurrent, and retrospective medical record reviews using electronic health record documentation and available claims information.
Identify and validate documented chronic conditions relevant to applicable risk adjustment programs, including reviewing new patients and identifying potential documentation opportunities for patients with upcoming visits.
Evaluate documentation for clinical support and accuracy in accordance with established clinical, documentation, and coding guidelines.
Apply CMS risk adjustment principles, HCC models, ICD-10-CM coding, and organizational guidelines in medical record reviews.
Serve as a clinical resource for staff on medical record review and documentation questions.
Conduct quality assurance audits of completed medical record reviews and abstractions, monitor adherence to guidelines and standard work, and provide timely, constructive feedback.
Identify trends and opportunities for clinical education, workflow improvement, and greater consistency; collaborate with leadership and clinical resources to clarify guidelines and standardize processes.
Support the development and implementation of quality improvement initiatives.
Monitor team productivity, quality, throughput, and performance metrics; review operational data to identify workflow barriers and efficiency improvements.
Promote consistent workflows and identify opportunities to improve documentation accuracy and appropriate identification of risk-adjustable conditions.
Escalate significant clinical, operational, compliance, or workflow concerns to appropriate leadership.
Participate in implementing and monitoring new processes, tools, and risk adjustment initiatives.
Participate in employee interviewing, selection, onboarding, orientation, and training; plan, assign, and direct daily work.
Coach and develop staff, evaluate performance, provide regular feedback, identify development and educational needs, and address performance or workflow concerns under organizational policies.
Support a collaborative work environment focused on quality, accountability, and continuous improvement.
Collaborate with clinicians, coding teams, Risk Adjustment leadership, Analytics, and other operational partners.
Support clinician education related to clinical documentation and applicable risk adjustment programs and serve as a resource for related workflow questions.
Support communication between frontline staff, clinicians, operational teams, and leadership and participate in processes supporting Optum Massachusetts risk adjustment objectives.