Manager Clinical SME, Clinical Documentation Integrity- Revenue Cycle - Remote

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.

The Manager and Clinical Consultant, Clinical Documentation Integrity in Optum Advisory Services, Finance & Operations serves as a clinical consultant and 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 coding optimization (profee, outpatient, and inpatient), CDI programmatic optimization and/or design and launch, 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

Primary Responsibilities:

Serves as clinical consultant and 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
Applies knowledge of change management principles to drive implementation of engagement objectives
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
Provides subject matter expertise to contribute to new product development (e.g., development of ambulatory CDI program) as well as the enhancement of existing solutions
Leverages and contributes to the applicable knowledge repositories (e.g., Microsoft Teams, SharePoint, analysis tools, project toolkits)
Contributes to practice-level initiatives, including business development and thought leadership, beyond client project work, including preparation for and participation in clinical revenue cycle business development meetings, demonstration of solutions, and overall pipeline development / strategy
Serves as a clinical subject matter expert for business development activities, 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 and expertise

The successful candidate will possess the following characteristics:

Ability to effectively engage, educate and present to clinicians and physicians around documentation concepts
Knowledge of ICD-10-CM / PCS, CPT, HCPCS, HCC, and modifier coding and specificity of documentation changes
Knowledge of ambulatory clinical documentation terrain, with emphasis on risk-based documentation accuracy optimization and concepts across HCC capture, RAF gap closures, pre-visit planning, and strategic patient activation
Ability to work as part of 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 (e.g. CDI program assessments, development of an education and audit program, etc.)
Exceptional written and verbal communication skills
Proven ability to drive quantifiable results
Ability to work independently with minimal supervision
Solid critical thinking, relationship building, and time management skills
Proficient in Microsoft suite, including Outlook, Excel, Word, and PowerPoint

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)
Certified Clinical Documentation Specialist (CCDS) credential
3 years of clinical documentation integrity focused experience within a healthcare provider setting
Experience facilitating the formal 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 acute care clinical documentation
Willingness to learn and expand clinical knowledge to ambulatory care setting
Willingness to travel to client onsites as needed (up to 70%)
Preferred location: Colorado Springs, CO, Dallas, TX, Hartford, CT, Pittsburgh, PA, Boulder, CO, Houston, TX, Nashville, TN, Tampa, FL, Eden Prairie, MN, Phoenix, AZ, St. Louis, MO

Preferred Qualifications:

3 years of clinical documentation integrity professional services and consulting experience at a consulting firm
Knowledge and experience across the ambulatory care settings (fee for service and clinical risk adjustment)

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

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.







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.