Manager Clinical Documentation Integrity- Stockton, CA

$5,000 Sign On Bonus For External Candidates

Healthcare isn’t just changing. It’s growing more complex every day. ICD - 10 Coding replaces ICD - 9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and Healthcare organizations continue to adapt, and we are vital part of their evolution. And that’s what fueled these exciting new opportunities.

Who are we? Optum360. We’re 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 our compassion, our talent, our resources and experience to bring financial clarity and a full suite of Revenue Management services to Healthcare Providers, nationwide.

If you’re looking for a better place to use your passion, your ideas 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 Clinical Document Integrity Service Area Manager is responsible for providing CDI program oversight and day to day CDI implementation of processes related to the concurrent review of the clinical documentation in the inpatient medical record of Optum 360 clients’ patients.  The goal of the LCDS oversight and practice is to support the CDI Director function by providing staff oversite, serve as an additional resource as well as perform CDI role function.  The Manager will assure via assessment, and teaching staff and providers the technical accuracy, specificity, and completeness of provider clinical documentation, and to ensure that the documentation explicitly identifies all clinical findings and conditions present at the time of service.  

This position collaborates with CDI Director, providers and other healthcare team members to make improvements that result in accurate, comprehensive documentation that reflects completely, the clinical treatment, decisions, and diagnoses for the patient.  The CDS utilizes clinical expertise and clinical documentation improvement practices as well as facility specific tools for best practice and compliance with the mission/philosophy, standards, goals and core values of Optum 360.  This position does not have patient care duties, does not have direct patient interactions, and has no role relative to patient care. 

Possibility of up to 25% required travel between facilities.

Primary Responsibilities: 

• Direct employee oversite
• Oversees CDI staff training and orientation
• Oversees and leads workflow for CDI staff
• Ensures adequate staffing for the workload, and steps in to assist teams when workload is in excess of what the team can complete
• Assists CDI Director with chart audits, quality audit and KPI audits
• Assists CDI Director with running reports, attends on site meetings as directed
• Develops physician teaching and on-site presentations
• Assist CDI Director with projects or tasks as needed
• Timecard approval
• Coaching, Performance management
• Evaluations
• Other duties as assigned 
• Communicates performance expectation of leadership to staff level CDI staff.
• Oversees that CDI staff are providing 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 patient condition and acuity of care provided
• Ensures and oversees 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
• Provides face-to-face educational opportunities with physicians.
• 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
• Ensures timely feedback to providers regarding clinical documentation opportunities for improvement and successes
• Ensures effective utilization of the CAC / Midas Clinical Documentation Integrity Focus Study, ensuring documentation of all verbal, written, electronic clarification activity
• Utilizes only the Optum360 approved forms, whether paper or electronic
• Proactively develops a reciprocal relationship with the HIM Coding Professionals
• Coordinate and conducts regular meetings with HIM Coding Professionals to monitor retrospective query rate and address issues
• Engages and consults with Physician Advisor 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:

• Associates Degree (or higher)
• RN (Registered Nurse) or Foreign Medical Graduate with 3 years of CDI (Clinical Documentation Integrity) experience
• CCDS, CDIP or CCS certification
• Experience with Acute Inpatient CDI
• Experience with Microsoft Word (create correspondence and work within templates), Microsoft Excel (data entry, sort / filter, and work within tables) and Microsoft Outlook (email and calendar management)
• Ability to lead projects with complex responsibilities and timelines or team leadership experience.
• Ability to travel up tp 25% of the time
• 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:

• Bachelor’s of Nursing degree (if an RN)
• Experience in case management and/or critical care
• CDI Supervisor or Management experience

 Soft Skills:

• Ability to multi-task
• Excellent verbal and written skills including strong organizational skills 
• Experience creating presentations and presenting  
• Comfortable communicating and working closely with Physicians

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

Careers with Optum360. At Optum360, we're on the forefront of health care innovation. With health care costs and compliance pressures increasing every day, our employees are committed to making the financial side more efficient, transferable and sustainable for everyone. We're part of the Optum and UnitedHealth Group family of companies, making us part of a global effort to improve lives through better health care. In other words, it's a great time to be part of the Optum360 team. Take a closer look now and discover why a career here could be the start to doing your life's best work.^SM

**PLEASE NOTE** The sign on bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or related entity in a full time, part time, or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus.

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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