Manager – Clinical Documentation Integrity

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.  

Primary Responsibilities\:

• Coordinate with CDI program lead India (Associate Director)  in driving workflow for CDI staff
• Assist and coordinate with CDI staff training and orientation
• Assists CDI program lead India (Associate Director) with chart audits, quality audit and KPI audits
• Ensures adequate staffing for the workload, and steps in to assist teams when workload is in excess of what the team can complete
• Develops physician teaching and presentations whenever needed
• Assist CDI program lead with projects or tasks as needed
• Time card approval
• Evaluations on regular basis of the team to make sure quality of the team is maintained
• 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
• Be able to identify 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 support for overall improvement in clinical documentation by providing proficient level review and assessment, and effectively articulating the rational for the recommendations
• Ensures timely feedback to providers regarding clinical documentation opportunities for improvement and successes
• Ensures effective utilization of the CAC / Midas Clinical Documentation Improvement Focus Study, ensuring documentation of all verbal, written, electronic clarification activity
• Utilizes only the approved forms for raising physician queries, whether paper or electronic
• Proactively fosters a collaborative, reciprocal relationship with Medical Coding Professionals to resolve discrepancies through clinical validation.
• Coordinate and conduct regular meeting to monitor retrospective query rate and address issues
• Engages with domestic team partner/manager when needed in regular calls, per the escalation process, to resolve provider issues regarding answering clarifications and participation in the clinical documentation improvement process
• Actively engages with the Quality Management teams to continually evaluate and spearhead clinical documentation improvement opportunities
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.  

Primary Responsibilities\:

• Coordinate with CDI program lead India (Associate Director)  in driving workflow for CDI staff
• Assist and coordinate with CDI staff training and orientation
• Assists CDI program lead India (Associate Director) with chart audits, quality audit and KPI audits
• Ensures adequate staffing for the workload, and steps in to assist teams when workload is in excess of what the team can complete
• Develops physician teaching and presentations whenever needed
• Assist CDI program lead with projects or tasks as needed
• Time card approval
• Evaluations on regular basis of the team to make sure quality of the team is maintained
• 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
• Be able to identify 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 support for overall improvement in clinical documentation by providing proficient level review and assessment, and effectively articulating the rational for the recommendations
• Ensures timely feedback to providers regarding clinical documentation opportunities for improvement and successes
• Ensures effective utilization of the CAC / Midas Clinical Documentation Improvement Focus Study, ensuring documentation of all verbal, written, electronic clarification activity
• Utilizes only the approved forms for raising physician queries, whether paper or electronic
• Proactively fosters a collaborative, reciprocal relationship with Medical Coding Professionals to resolve discrepancies through clinical validation.
• Coordinate and conduct regular meeting to monitor retrospective query rate and address issues
• Engages with domestic team partner/manager when needed in regular calls, per the escalation process, to resolve provider issues regarding answering clarifications and participation in the clinical documentation improvement process
• Actively engages with the Quality Management teams to continually evaluate and spearhead clinical documentation improvement opportunities
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications\:

• MBBS (Indian or Foreign Medical Graduate)
• 1+ years of experience with corporate especially US healthcare
• Solid understanding of Microsoft, Word, Excel, and work-related software

Preferred Qualifications\:

• MBBS (Indian/FMG) degree
• Supervisor or Management experience
• Experience in case management and/or critical care
• Experience with EHR/EMR
• Proven ability to projects with complex responsibilities and timelines
• Proven excellent verbal and written skills including solid organizational skills
• Proven ability to multi-task

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.

Required Qualifications\:

• MBBS (Indian or Foreign Medical Graduate)
• 1+ years of experience with corporate especially US healthcare
• Solid understanding of Microsoft, Word, Excel, and work-related software

Preferred Qualifications\:

• MBBS (Indian/FMG) degree
• Supervisor or Management experience
• Experience in case management and/or critical care
• Experience with EHR/EMR
• Proven ability to projects with complex responsibilities and timelines
• Proven excellent verbal and written skills including solid organizational skills
• Proven ability to multi-task

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.