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. 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.
In this position the CDS will utilizing the Optum™ CDI 3D technology that is assisting hospitals to improve data quality to accurately reflect the quality of care provided and ensure revenue integrity.
- Increase in identification of cases with CDI opportunities, with automated review of 100% of records
- Improved tracking, transparency and reporting related to CDI impact, revenue capture, trending and compliance
- Easing the transition to ICD-10 by improving the specificity and completeness of clinical documentation, resulting in more accurate coding
- 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 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 and provides Working DRG lists to Care Coordination
- 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 Midas or Optum® CDI 3D Technology to document all verbal, written, electronic clarification activity
- Utilizes only the Optum360 approved clarification forms
- Proactively develops a reciprocal relationship with the HIM Coding Professionals
- Coordinates and conducts regular meeting with HIM Coding Professionals to reconsolidate DRGs, monitor retrospective query rates and discuss questions related to Coding and CDI
- Engages and consults with Physician Advisor /VPMA 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
- 5+ years acute care hospital clinical RN experience with hospital Case Management experience or CDI experience OR Medical Graduate with CDI experience
- Must have proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point and Electronic Medical Records
- Experience communicating & working closely with Physicians
CCDS, CDIP or CCS certification
At least 1+ year of Clinical Documentation Improvement experience – conducting reviews, sending queries and educating physicians
BSN degree if a RN
CAC experience (Computer Assistant Coding)
OB experience is a plus
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.