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Registered Nurse, Clinical Documentation Improvement Specialist - Remote in Madison WI job in Houston at UnitedHealth Group

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Registered Nurse, Clinical Documentation Improvement Specialist - Remote in Madison WI at UnitedHealth Group

Registered Nurse, Clinical Documentation Improvement Specialist - Remote in Madison WI

UnitedHealth Group Houston, TX (Remote) Full-Time

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm) 





Health care isn't just changing. It's growing more complex every day. ICD10 replaces ICD9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and health care organizations continue to adapt, and we are a vital part of their evolution. And that's what fueled these exciting new opportunities. Optum360 is a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, we'll leverage all our resources to bring financial clarity and a full suite of revenue management services to health care providers nationwide. If you're looking for a better place to use your passion and your desire to drive change, this is the place to be. 





If you are located in Madison, WI, you will have the flexibility to work remotely* as you take on some tough challenges.





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 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





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:




  • Active and unrestricted RN license in the state of Wisconsin with 2+ years of acute care experience

  • Experience as a Clinical Documentation Integrity Specialist

  • Experience communicating & working closely with Physicians

  • Basic proficiency using a PC in a Windows environment, including Microsoft Word, Excel, and Electronic Medical Records (EPIC is preferred)

  • Ability to work onsite on an as needed basis (typically 1x/month)

  • Ability to travel up to 10%

  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation





Preferred Qualifications:




  • Current certification as a CCDS, CDIP or CCS

  • Experience working in critical care, ICU, trauma, cardiothoracic or related

  • Experience in case management

  • Excellent verbal and written skills including solid organizational skills





To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment





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 employees working remotely 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.

Recommended Skills

  • Cardiothoracic Surgeries
  • Care Coordination
  • Case Management
  • Certified Coding Specialist
  • Clinical Works
  • Communication
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