For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)
The Clinical Document Improvement Specialist - (CDS) 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 CDS oversight and practice is to 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 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. Utilizing clinical expertise and clinical documentation improvement practices and 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.
***$5,000 sign on bonus for external candidates***
This is a full time position, Monday-Friday, day hours at North Shore University Hospital
This position has the possibility of work at home two times a week once you are meeting all job standards and competent in your abilities
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
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 facility/Optum 360 approved forms, whether paper or electronic
Steers the development and implementation of education plans for the interdisciplinary care team to promote accurate and complete documentation in the medical record
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 to resolve provider issues regarding answering clarifications and participation in the clinical documentation improvement process
Actively engages Case Management and RAC committee to continually evaluate and spearhead clinical documentation improvement opportunities to reduce denials and support medical necessity
- RN with 5+ years of clinical experience working in an inpatient hospital, acute care setting OR a Medical Graduate with CDI experience
- Computer proficiency: recent working experience with Microsoft Outlook, Word, Excel and ability to navigate in a Windows based environment
- Coding experience
- Previous CDI experience - conducting efficient and regular documentation reviews and evaluating the quality and efficiency of documentation practice
- Chart review experience
- CDI Specialist Certification through AHIMA or ACDIS
- Ability to interact with physicians and adapt communication style
- Strong organizational skills
- Effective verbal and written communication skills; ability to give presentations
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)
**PLEASE NOTE** The sign on bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time, or per diem basis (“Internal Candidates”) are not eligible to receive a sign on bonus.
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.
Key Words: ICD 9, ICD 10, CCS, coding, RN, Registered Nurse, Nurse, critical care, BSN, clinical documentation improvement, CDIS, CCDS, CDI, DRG, CDIP, chart review, North Shore University Hospital, Manhasset, N, New York