For those who want toinvent the future of health care, here's your opportunity. We're going beyondbasic care to health programs integrated across the entire continuum of care.Join us and help people live healthier lives while doing your life'sbest work.(sm)

The ClinicalDocument Improvement Specialist - (CDS) is responsible for providingCDI program oversight and day to day CDI implementation of processes related tothe concurrent review of the clinical documentation in the inpatient medicalrecord of Optum 360 clients' patients. The goal of the CDS oversight andpractice is to assess the technical accuracy, specificity, and completeness ofprovider clinical documentation, and to ensure that the documentationexplicitly identifies all clinical findings and conditions present at the timeof service.

This position collaborates with providers and other healthcare team members tomake improvements that result in accurate, comprehensive documentation thatreflects completely, the clinical treatment, decisions, and diagnoses for thepatient. The CDS utilizes clinical expertise and clinical documentationimprovement practices as well as facility specific tools for best practice andcompliance with the mission/philosophy, standards, goals and core values of Optum360.

In this position the CDSwill utilizing the Optum CDI 3D technology that is assisting hospitals toimprove data quality to accurately reflect the quality of care provided andensure revenue integrity.

Our three-dimensionalapproach to CDI technology, paired with best-practice adoption methodology andchange management support, is helping hospitals make a real impact on CDIefficiency and effectiveness.

• Increasein identification of cases with CDI opportunities, with automated review of 100% of records
• Improvedtracking, transparency and reporting related to CDI impact, revenue capture, trending andcompliance
• Easingthe transition to ICD-10 byimproving the specificity and completeness of clinical documentation, resultingin more accurate coding

This position does nothave patient care duties, does not have direct patient interactions, and has norole relative to patient care.

This is an onsite position at Methodist Hospitalin Sacramento, CA

PrimaryResponsibilities:

• Provides expert levelreview of inpatient clinical records within 24-48 hours of admit; identifiesgaps in clinical documentation that need clarification for accurate codeassignment to ensure the documentation accurately reflects the severity of thecondition and acuity of care provided
• Conducts daily follow-upcommunication with providers regarding existing clarifications to obtain neededdocumentation specificity
• Provides expert levelleadership for overall improvement in clinical documentation by providingproficient level review and assessment, and effectively articulatingrecommendations for improvement, and the rational for the recommendations
• Actively communicateswith providers at all levels, to clarify information and to communicatedocumentation requirements for appropriate diagnoses based on severity ofillness and risk of mortality
• Performs regularrounding with unit-based physicians and provides Working DRG lists to CareCoordination
• Provides face-to-faceeducational opportunities with physicians on a daily basis
• Provides complete followthrough on all requests for clarification or recommendations for improvement
• Leads the developmentand execution of physician education strategies resulting in improved clinicaldocumentation
• Provides timely feedbackto providers regarding clinical documentation opportunities for improvement andsuccesses
• Ensures effectiveutilization of Midas or Optum CDI 3D Technology to document all verbal,written, electronic clarification activity
• Utilizes only theOptum360 approved clarification forms
• Proactively develops areciprocal relationship with the HIM Coding Professionals
• Coordinates and conductsregular meeting with HIM Coding Professionals to reconcile DRGs, monitorretrospective query rates and discuss questions related to Coding and CDI
• Engages and consultswith Physician Advisor /VPMA when needed, per the escalation process, toresolve provider issues regarding answering clarifications and participation inthe clinical documentation improvement process
• Actively engages withCare Coordination and the Quality Management teams to continually evaluate andspearhead clinical documentation improvement opportunities

You'll be rewarded and recognized for your performance inan environment that will challenge you and give you clear direction on what ittakes to succeed in your role as well as provide development for other rolesyou may be interested in.

• 5+ years of acute care hospital clinical RN experience OR Medical Graduate with 1 of year CDI experience
• Proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point and Electronic Medical Records
• Experience communicating & working closely with Physicians

Preferred Qualifications:

• CCDS, CDIP or CCS certification
• BSN degree, if a RN
• CAC experience (Computer Assistant Coding)
• Currently a Clinical Documentation Improvement specialist with at least 1 year of experience conducting reviews, sending queries and educating physicians

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.

Job Keywords: RN, Registered Nurse, CCDS, Certified Clinical Documentation Specialist, CDIP, Clinical Documentation Improvement Professional, CCS, Certified Coding Specialist, Doctor, Physician, CDI, Methodist Hospital, Sacramento, CA, California