Optum
Clinical Document Improvement Specialist - Sacramento, CA
Optum, Sacramento, California, United States, 95828
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start
Caring. Connecting. Growing together.
The Clinical Document Improvement Specialist Lead - (LCDS) 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 the LCDS oversight and practice is to support the CDI manager function by providing staff oversite, serve as an additional resource as well as perform CDI role function. LCDS will assess the technical accuracy, specificity, and completeness of provider clinical documentation, and to ensure that the documentation explicitly identifies all clinical findings and conditions present at the time of service.
This position collaborates with CDI manager, 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.
This will be an office position located at Mercy General Hospital in Sacramento, CA.
Travel 25% of the time to the following locations:
Mercy Hospital Folsom
Mercy San Juan Hospital
Mercy General Hospital
Sierra Nevada Memorial Hospital
Woodland Healthcare Hospital
Methodist Hospital of Sacramento
Primary Responsibilities:
Provides 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
Conducts daily follow-up communication with providers regarding existing clarifications to obtain needed documentation specificity
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 on a daily basis
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
Provides timely feedback to providers regarding clinical documentation opportunities for improvement and successes
Ensures effective utilization of the Midas Clinical Documentation Improvement Focus Study, documenting 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 conducts regular meeting 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 to continually evaluate and spearhead clinical documentation improvement opportunities
Lead CDI Responsibilities:
Assists CDI Manager with chart audits, quality audit and KPI audits
Assists CDI Manager with running reports, attends on site meetings as directed
Assists CDI staff training and orientation
Oversees and leads workflow for CDI staff
Develops physician teaching and on site presentations
Assist CDI manager with projects or tasks as needed
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. Required Qualifications:
5+ years acute care hospital clinical RN experience OR Foreign Medical Graduate with CDI experience
2+ years of experience in clinical documentation improvement
Demonstrated proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point and Electronic Medical Records
Experience communicating & working closely with Physicians
Ability to travel 25%
Preferred Qualifications:
BSN degree or equivalent
CCDS, CDIP or CCS certification
Experience in case management and/or critical care
Ability to lead projects with complex responsibilities and timelines
Leadership experience
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
#J-18808-Ljbffr
Caring. Connecting. Growing together.
The Clinical Document Improvement Specialist Lead - (LCDS) 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 the LCDS oversight and practice is to support the CDI manager function by providing staff oversite, serve as an additional resource as well as perform CDI role function. LCDS will assess the technical accuracy, specificity, and completeness of provider clinical documentation, and to ensure that the documentation explicitly identifies all clinical findings and conditions present at the time of service.
This position collaborates with CDI manager, 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.
This will be an office position located at Mercy General Hospital in Sacramento, CA.
Travel 25% of the time to the following locations:
Mercy Hospital Folsom
Mercy San Juan Hospital
Mercy General Hospital
Sierra Nevada Memorial Hospital
Woodland Healthcare Hospital
Methodist Hospital of Sacramento
Primary Responsibilities:
Provides 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
Conducts daily follow-up communication with providers regarding existing clarifications to obtain needed documentation specificity
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 on a daily basis
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
Provides timely feedback to providers regarding clinical documentation opportunities for improvement and successes
Ensures effective utilization of the Midas Clinical Documentation Improvement Focus Study, documenting 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 conducts regular meeting 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 to continually evaluate and spearhead clinical documentation improvement opportunities
Lead CDI Responsibilities:
Assists CDI Manager with chart audits, quality audit and KPI audits
Assists CDI Manager with running reports, attends on site meetings as directed
Assists CDI staff training and orientation
Oversees and leads workflow for CDI staff
Develops physician teaching and on site presentations
Assist CDI manager with projects or tasks as needed
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. Required Qualifications:
5+ years acute care hospital clinical RN experience OR Foreign Medical Graduate with CDI experience
2+ years of experience in clinical documentation improvement
Demonstrated proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point and Electronic Medical Records
Experience communicating & working closely with Physicians
Ability to travel 25%
Preferred Qualifications:
BSN degree or equivalent
CCDS, CDIP or CCS certification
Experience in case management and/or critical care
Ability to lead projects with complex responsibilities and timelines
Leadership experience
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
#J-18808-Ljbffr