Optum Hiring For Clinical Documentation Integrity Specialist at St. Louis, MO  Full Time

• 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 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 reconcile 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:

• 3+ years of acute care hospital clinical RN experience OR Foreign Medical Graduate with CDI experience
• Experience in Clinical Documentation Improvement
• Proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point, and Electronic Medical Records
• Experience communicating & working closely with Physicians
• Full COVID-19 vaccination is an essential requirement 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