[Hiring] Manager, Clinical Documentation Integrity @UnitedHealth Group

Role Description

The Clinical Document Improvement Specialist Manager 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 LCDS oversight and practice is to support the CDI manager function by providing staff oversight, serving as an additional resource, and performing CDI role functions. The Manager will assure via assessment and teaching staff and providers the technical accuracy, specificity, and completeness of provider clinical documentation, ensuring that the documentation explicitly identifies all clinical findings and conditions present at the time of service.

This position collaborates with the CDI Director, providers, and other healthcare team members 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. This position does not have patient care duties, does not have direct patient interactions, and has no role relative to patient care.

Travel is required to client locations.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary 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
• Oversees and leads workflow for CDI staff
• Develops physician teaching and on-site presentations
• Assists CDI Director with projects or tasks as needed
• Timecard approval
• Coaching
• Evaluations
• Other duties as assigned
• Communicates performance expectations of leadership to staff-level CDI staff
• Oversees 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
• Ensures and oversees daily follow-up communication with providers regarding existing clarifications to obtain needed documentation
• Provides expert-level leadership for overall improvement in clinical documentation by providing proficient level review and assessment, and effectively articulating recommendations for improvement
• Actively communicates with providers at all levels to clarify information and to communicate documentation requirements for appropriate diagnoses
• 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
• Coordinates and conducts 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
• Actively engages with Care Coordination and the Quality Management teams
• Uses enterprise-approved AI tools to streamline workflows, automate tasks, and drive continuous improvement
• Evaluates emerging trends to inform solution design and strategic innovation

Qualifications

• 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, PowerPoint, and Electronic Medical Records
• Ability to travel 30-40% to client sites

Requirements

• CCDS, CDIP, or CCS certification (preferred)
• People management experience (preferred)
• Experience in Clinical Documentation Improvement (preferred)
• CAC experience (Computer Assistant Coding) (preferred)

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (subject to eligibility requirements)

Company Description

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable, and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard, and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences, and perspectives.