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CDI Specialist, RN - Remote in WI

Company: UnitedHealth Group
Location: Las Vegas
Posted on: September 14, 2023

Job Description:

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.--

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 within a 2 hour radius of Madison, WI, you will have the flexibility to work remotely* as you take on some tough challenges.
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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. Candidates in consideration must live within a commutable distance to Madison, WI as occasional onsite travel is required.


    Required Qualifications:
    • Active and unrestricted RN license in your state of residency AND 2+ years of acute care experience working in critical care, ICU, trauma, ED, cardiothoracic or other critical care areas
    • 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)
    • Live within a 2 hour radius of Madison, WI for occasional onsite travel
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      Preferred Qualifications:
      • Current certification as a CCDS, CDIP or CCS
      • 2+ years of experience working in a CDI role
      • Experience working as a Clinical Documentation Integrity (CDI) Specialist
      • Experience in case management
      • Excellent verbal and written skills including solid organizational skills

        *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.--

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        At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

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        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.

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        UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: UnitedHealth Group, Las Vegas , CDI Specialist, RN - Remote in WI, Healthcare , Las Vegas, Nevada

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