Note: The job is a remote job and is open to candidates in USA. Optum hires a Manager, Clinical Documentation Integrity to oversee CDI program implementation and staff supporting Optum 360 clients. The role leads concurrent inpatient documentation review, staff development, provider education, and collaboration with healthcare teams to improve the accuracy and completeness of clinical documentation.
Responsibilities
- Conducts chart audits, quality audit and KPI audits
- Conducts CDI Manager with running reports, attends on site meetings as directed
- Oversees CDI staff training and orientation
- Overseas and leads workflow for CDI staff
- Develops physician teaching and on-site presentations
- Assist CDI Director with projects or tasks as needed
- Timecard approval
- Coaching
- Evaluations
- Other duties as assigned
- Communicates performance expectation of leadership to staff level CDI staff
- Oversee that CDI staff are providing 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 patient condition and acuity of care provided
- Ensures and oversee daily follow-up communication with providers regarding existing clarifications to obtain needed documentation specifically
- 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
- Performs regular rounding with unit-based physicians
- Provides face-to-face educational opportunities with physicians
- Provides complete follow-through on all requests for clarification or recommendations for improvement
- Leads the development and execution of physician education strategies resulting in improved clinical documentation
- Ensures timely feedback to providers regarding clinical documentation opportunities for improvement and successes
- Ensures effective utilization of the CAC tool, ensuring documentation of all verbal, written, electronic clarification activity
- Utilizes only the Optum360 approved forms, whether paper or electronic
- Proactively develops a reciprocal relationship with the HIM Coding Professionals
- Coordinate and conduct regular meetings with HIM Coding Professionals to monitor retrospective query rate and address issues
- Engages and consults with Physician Advisor when needed, per the escalation process, to resolve provider issues regarding answering clarifications and participation in the clinical documentation improvement process
- Actively engages with Care Coordination and the 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
Skills
- 3+ years of acute care hospital clinical RN experience OR Medical Graduate with CDI experience and CDI certification (CCDS, CDIP)
- 2+ years of experience communicating & presenting to Physicians
- Proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point and Electronic Medical Records
- CCDS, CDIP or CCS certification
- People management experience
- Experience in Clinical Documentation Improvement
- CAC experience (Computer Assistant Coding)
Benefits
- Work remotely from anywhere within the U.S.
- Development for other roles you may be interested in
- A comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
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