Director and Clinical SME

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)The Director and Clinical Subject Matter Expert, Clinical Documentation Integrity in Optum Advisory Services, Finance & Operations serves as a clinical 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.You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:Serves as clinical 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 practiceIdentifies 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 recommendationsSupports 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 tacticsCommunicates effectively and accurately in writing and verbally to prospects, members and other staffDemonstrates strong relationship management skills and ability to handle challenging interpersonal situationsCultivates 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 expectationsEnsures 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 objectivesLeverages 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 appropriateProvides 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 / strategyServes as a clinical subject matter expert for business development activities, participating in internal and client facing meetings as neededStays 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 teamShares professional and domain knowledge with peers and colleagues to build overall organization capabilities and expertiseYou’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 5+ years of clinical documentation integrity focused experience within a healthcare provider setting or a professional services (consulting) capacity Exceptional subject matter knowledge of clinical documentation, with experience across both the acute care and ambulatory care settingsExperience facilitating the 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 staffWillingness to travel to client onsites as needed (up to 70% when safe)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: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 changesKnowledge 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 activationAbility to work as part of team, meet deliverable deadlines, and collaborate with clinical and non-clinical team membersAbility to drill down to the root cause of client challenges and deploy creative problem solving to drive client resultsProficient in Microsoft suite, including Outlook, Excel, Word, and PowerPointExceptional written and verbal communication skillsProven ability to drive quantifiable results Ability to work independently with minimal supervisionSolid critical thinking, relationship building, and time management skillsTo protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employmentCareers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado/Connecticut/Nevada residents is $113,500 to $218,100. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.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.Brand: OptumInsightJob ID: 2076908Employment Type: Full-timeJob Area: Clinical