It's a given that health care is undergoing rapid and transformative change. The speed is breathtaking and accelerating every day. And UnitedHealth Group leads the industry with innovations that are shaping the future. As Manager of Compliance, you will manage a team responsible for monitoring changes with internal laws and regulations to ensure compliance with State and Federal guidelines. Not only will you be helping the health system work better for everyone, but you will do so with the support and resources of a Fortune 6 industry leader.
The Clinical Documentation Improvement (CDI) Quality Assurance Audit Manager provides expert quality auditing services across Dignity Health. The auditor reviews clinical documentation and related coding to verify completeness and accuracy of documentation in a manner consistent with relevant laws, regulations, clinical documentation, and coding standards. The Clinical Documentation Improvement Quality Assurance Audit Manager will provide education to CDI Specialists on audit results, utilize expertise to research and respond to challenging clinical documentation questions, develop and provide clinical documentation education and evaluate audit results to recommend corrective actions. The Clinical Documentation Improvement Quality Assurance Audit Manager will have the expertise to respond to client requests to conduct ad hoc CDI audits as well as collaborate with HIM/Coding operations to strengthen overall documentation, coding and billing compliance.
- Performs CDI audit assessments to facilitate improvement in the overall quality, completeness and accuracy of record documentation through data analysis, audit, and education of CDI specialists.
- Expert level knowledge of CDI process, including understanding of MS-DRGs, APR-DRGs, complications/co-morbidities (CCs), major complications/co-morbidities (MCCs), severity of illness, risk of mortality, best practice provider query standards, and coding guidelines
- Evaluates missed opportunities for CC/MCC, patient safety indicators (PSI), Hospital Acquired Conditions (HAC), opportunities for alternative principal diagnosis to contribute to overall completeness and accuracy of patient’s medical record
- Assists with audit requests from facility and/or CDI leadership, including auditing of targeted DRGs as part of quarterly assessments
- Evaluates queries sent by CDI staff for accuracy, completeness, and compliance with best practice standards
- Develops and maintains a collaborative working relationship with CDI Personnel, HIM Management, Coders and CDI Leadership.
- Presents recommendation to CDI Leadership regarding documentation opportunities, process effectiveness, and education opportunities
- Provides appropriate educational follow-up with individual CDI specialist or group based on identified deficiencies during audit process in accordance with UHG cultural values
- Compiles, analyzes and evaluates data and presents results in a meaningful format to varying levels of leadership within Optum360.
- Evaluates adherence to Optum360 best-practice CDI workflow utilizing eCAC/CDI3D technology (including facility specific exceptions). This includes, but is not limited to, review comments, assigning accurate working DRG, addressing markers, checkmark placement, documentation of escalation, etc.
- Identifies clinical documentation patterns and trends and recommends areas of improvement as appropriate. This includes collaboration with denials management team to provide feedback to CDI staff on denials due to inadequate documentation
- Coaches and assists in developing CDI specialists and ensures continuing education is maintained.
- Assists in identifying CDI issues and concerns, and communicating those issues and concerns accurately, timely, and proficiently to the CDI Director and to the Director of Clinical Coding Department.
- Demonstrates successful completion of ongoing proficiency and compliance with regulatory requirements.
- Assists in ongoing education to CDI associates and specialists, Coders, etc. related to documentation changes, compliance issues, profiling concerns, and reimbursement changes.
- Conduct data and root cause analysis and share findings via formal reporting mechanisms with CDI Leadership.
The fundamental question you'll be faced with every day is are we investigating the right things? That's not an easy question and requires a deep knowledge of the industry and the issues at hand, even as they change. You will also be responsible for promoting compliance activities and collaborating with stakeholders at all levels of the organization.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Clinical Documentation Improvement Practitioner CDIP, or
- Certified Clinical Documentation Specialist CCDS, and
- Registered Nurse (RN) or Registered Health Information Administrator ( RHIA) and/or CCS
REQUIRED EDUCATION AND EXPERIENCE:
- Bachelor's Degree or equivalent in healthcare field; and/or combination of education and 5 years' experience.
- Minimum of 4 years CDI experience in an acute inpatient setting
- Certified Coding Specialist (CCS) certification
- Prior experience as CDI auditor/trainer preferred
- Excellent written and spoken communication abilities
- Advanced experience with Microsoft Office
- Management experience, including providing feedback to staff
- Experience as a CDI auditor/trainer
- Strong data analysis skills
UnitedHealth Group is a global organization that's making a difference in the lives of more than 85 million people. We are leading health care forward to help everyone live healthier lives. Come join us. And get started doing your life's best work.SM
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: quality assurance, clinical, audit, leadership, evaluate, coach, telecommute, telecommuter, remote, work from home