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***Director Clinical Documentation Integrity - Remote job in New York at UnitedHealth Group

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***Director Clinical Documentation Integrity - Remote at UnitedHealth Group

***Director Clinical Documentation Integrity - Remote

UnitedHealth Group Work from Home/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)



The Director and Clinical Subject Matter Expert, Clinical Documentation Integrity in Optum Advisory Services, 

Finance & Operations serves as a clinical subject matter expert for engagements with healthcare provider clients across a range of projects, primarily focused on acute care and ambulatory clinical documentation integrity and provider engagement and education in clinical documentation. Additional clinical revenue cycle projects may focus across CDI programmatic optimization and/or design and launch, coding optimization (profee, outpatient, and inpatient), and coding and CDI organizational structure redesign, optimization, and centralization. While not a principal focus of this role, project efforts may require collaboration with key teams typically outside of the revenue cycle, such as care management, utilization review, population health, and other key areas as needed.



The ideal candidate will possess deep clinical documentation integrity background and experience working with provider organizations across both acute care and ambulatory settings, with deep knowledge of both DRG-based documentation optimization as well as ambulatory fee-for-service (evaluation & management coding, CPTs) and risk-based documentation (HCC capture, RAF gap closure).



Primary Responsibilities:

Key responsibilities of the Director and Clinical SME, CDI role will include:




  • Serves as clinical subject matter expert for clinical engagements, with emphasis on clinical documentation integrity (acute care and ambulatory)

  • Demonstrates sufficient executive presence to lead onsite presentations, including key client executive leadership sessions and provider education sessions (group and individual)

  • Assists consulting team in accurately diagnosing client clinical revenue cycle improvement opportunities and issues and determines the appropriate solutions that will lead the client to achieve best practice

  • Identifies needed data/information for the engagement and provides subject matter expertise as need in conducting  appropriate analyses (e.g., CMI analytics, provider outlier analytics, CC/MCC analytics, HCC analytics)

  • Prepares customized client recommendations to realize improvement opportunities identified based on industry best practices and emerging ‘best-in-class’ approaches and facilitates implementation of recommendations

  • Supports presentation of clinical engagement deliverables to applicable stakeholders (e.g. diagnostic findings and recommendations, chart review findings, clinical documentation integrity improvement opportunities)

  • Conducts clinical analytics, such as professional, outpatient, and/or inpatient chart reviews and/or oversees chart review efforts conducted by third-party partners, providing guidance and quality assurance

  • Builds consensus among client stakeholders who play a critical key role in the health system’s ability to successfully implement the recommended strategies and tactics

  • Communicates effectively and accurately in writing and verbally to prospects, members and other staff

  • Demonstrates solid relationship management skills and ability to handle challenging interpersonal situations

  • Cultivates the client's perception of Optum as a trusted partner and strategic advisor (e.g., build credibility, demonstrate full understanding of their business, leverage other resources within OptumInsight)

  • Drives high levels of client satisfaction by driving results that meet or exceed the client's expectations

  • Ensures engagement quality through running to criticism with both team members and clients alike, regularly seeking proactive feedback and adjusting course as needed based on feedback provided

  • Leverages project documents and deliverables to provide re-use/transferability for other engagements (e.g., de-identifying content, cataloguing deliverables, storing documents in appropriate shared folders)

  • Identifies lessons learned and communicate to appropriate stakeholders across both internal team and client, as appropriate

  • Contributes to practice-level initiatives, including business development and thought leadership, beyond client project work, participating in internal and client facing meetings as needed

  • Stays current on important issues in the healthcare industry and maintains active participation in relevant professional organizations (e.g. ACDIS, AHIMA), sharing key trends and lessons learned back with broader team

  • Shares professional and domain knowledge with peers and colleagues to build overall organization capabilities



The successful candidate will possess the following characteristics:




  • Knowledge of ICD-10-CM / PCS, E&M, CPT, HCPCS, HCC, and modifier coding and documentation

  • Knowledge of ambulatory clinical documentation terrain, with emphasis across risk-based documentation accuracy optimization and concepts across HCC capture, RAF gap closures, pre-visit planning, and strategic patient activation

  • Proficient in Microsoft suite, including Outlook, Excel, Word, and PowerPoint

  • Ability to effectively engage, educate and present to clinicians and physicians around documentation concepts

  • Exceptional written and verbal communication skills

  • Proven ability to drive quantifiable results

  • Excellent critical thinking, relationship building, and time management skills

  • Ability to work independently with minimal supervision

  • Ability to work as part of a team, meet deliverable deadlines, and collaborate with clinical and non-clinical team members

  • Ability to drill down to the root cause of client challenges and deploy creative problem solving to drive client results





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:




  • U.S. Registered Nurse (RN) or Bachelor of Science in Nursing (BSN)

  • 5+ years of clinical documentation integrity focused experience within a healthcare provider setting or a professional services (consulting) capacity

  • Experience facilitating the exchange and delivery of information within all levels in a provider based, client organization, including, but not limited to: surgeons, anesthesiologists, hospital executives, and other professional and ancillary staff

  • Exceptional subject matter knowledge of clinical documentation, with experience across both the acute care and ambulatory care settings required for consideration

  • Willingness to travel to client onsites as needed (up to 70% when safe)

  • 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 Qualification:




  • Certified Clinical Documentation Specialist (CCDS) credential





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)





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.



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