Clinical Auditor Jobs in Hawaii

INTRODUCTION

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

ROLE AND RESPONSIBILITIES

The Clinical Document Integrity Specialist Manager is responsible for providing CDI program oversight and day-to-day CDI implementation of processes related to the review of the clinical documentation in the inpatient medical record of Optum 360 clients' patients. The Manager, with the support of the CDI Director, is responsible for providing staff oversight, assisting with monthly reporting, and auditing, as well as mentoring and orientation of new staff. The Manager is responsible for attending client meetings and creating and delivering of staff and provider education to ensure that the documentation explicitly identifies all clinical findings and conditions present at the time of service.

This position collaborates with the 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.

This is an onsite position based out of Queen's Medical Center, 1301 Punchbowl Street, Honolulu, Hawaii 96813.

Primary Responsibilities:

• Assists CDI Director with chart audits, quality audit, and KPI audits
• Assists CDI Director with running reports, attends on site meetings as directed
• 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 more than what the team can complete
• 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
• Oversee 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 rationale 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 CDI software, 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 conduct 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

BASIC QUALIFICATIONS

• RN with current Hawaii RN license or obtain within 90-days of hire date or Foreign Medical Graduate with at least 3 years of CDI experience
• CCDS, CDIP or CCS certification within six months of being in the role
• Ability to be comfortable communicating & working closely with Physicians
• Proven excellent verbal and written skills including solid organizational skills
• Proven solid understanding of Microsoft, Word, Excel, and work related software
• Ability to multi-task
• Ability to lead teams
• Ability to present, speak in public

PREFERRED QUALIFICATIONS

• Experience in case management and / or critical care
• CDI Supervisor or Management experience
• Ability to lead projects with complex responsibilities and timelines

COMPENSATION

• Salary Range: $91,700 to $163,700 annually based on full-time employment

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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