Optum Utilization Review Jobs in Connecticut (NOW HIRING)

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Position Summary:
The Clinical Documentation Integrity Supervisor provides a key role in facilitating long-term success of Clinical Documentation Integrity (CDI) by providing day-to-day oversight of the program. They also represent and support CDI at the regional/ facility levels as assigned.
The Clinical Documentation Supervisor will work in collaboration with the clinical documentation specialists (CDS), coding professionals, physicians, nursing staff and other patient care givers to ensure accurate and timely clinical documentation in the medical record. This role supports attaining appropriate DRGs, quality outcomes, and accurate coding based on sound clinical entries in the medical record.
The Clinical Documentation Supervisor will provide education, support, and mentoring of the Clinical Documentation Specialists and ensure correct standard work, policies, procedures and guidelines are followed.
Position Responsibilities:
Key Areas of Responsibility
Program Oversight
• Accountability for program and regional success, achievement of annual improvement priorities and key performance indicators.
• Day-to-day oversight and resource to the clinical documentation program.
• Develop a collaborative and effective clinical documentation team.
• Responsible for regional/facility accurate Case Mix Index (CMI), mortality observed to expected ratio (O:E), capture of appropriate severity of illness (SOI) and risk of mortality (ROM), risk adjustment and hierarchal condition capture (HCC) codes and other high quality documentation outcome measures.
• Management of CDI standard work, workflows, policies, and guidelines consistent with System best practices.
• Assist with CDI /Coding meetings, and facilitate H3W work group meetings and activities as needed.
• Provide CDS team, CDI and Revenue Cycle Leadership, physician leaders, all providers, quality management team, and coding teams ongoing feedback.
• Create relevant reports from Optum CAC CDI, Epic and facility data. Analyze data and recommend action planning to meet organizational and team goals.
• Disseminate reports and facility data to leadership teams.
• Provide necessary feedback and conflict resolution to clinical documentation team
• Track program successes and ongoing opportunities, create and initiate action plans as indicated, report trends and concerns to CDI Manager
Other Management
• Contributes to the efficient operation of the CDI department by establishing priorities, eliminating obstacles, and resolving problems.
• Provides ongoing feedback, coaching and mentoring, and assists in recruiting, developing and retaining Clinical Documentation Specialists (CDS). Ensures CDS' continuing education and that requirements for job role are maintained (licensing, certification, other requirements).
• Oversees and manages orientation activities for new CDS in collaboration with CDI Quality and Education Specialist.
• Establishes and maintains performance expectations of their employees and evaluates performance in a timely manner to enable employees to be successful in their roles.
• Develops and implements HHC Performance Improvement activities as needed
• Conducts timely written Performance Evaluation and 1:1 discussions under the direction of CDI Manager/Director.
• Provides CDI subject matter expert guidance to CDS team, coding, physician leadership, quality management, utilization management, all providers, and others as required.
• Assists in developing clinical documentation standard work, policies, procedures, workflows, and guidelines and educates staff.
• Facilitates CDI H3W work group as needed
• Assists manager with other tasks as necessary, provides coverage and back up when manager is absent.
Documentation Review
• Day to day clinical documentation reviews and second level reviews as needed, initiate and complete compliant queries and follow-up reviews. Coaches and mentors CDS on CDI opportunities and compliant queries, assists in development of query templates and smartphrases.
• Inputs review workflows, accurate data, and CDI query impact into Optum and EPIC. Understands CDI query impact methodology and is able to identify discrepancies and coach CDI team to make needed corrections for query impact.
• Collaborates with coding leadership to determine appropriate Medicare Severity-Diagnosis Related Group (MS-DRG, APR-DRGs, etc.) assignment for compliance and reimbursement purposes.
• Works with Coding and Quality Management teams to appropriately identify compliant query opportunities regarding Hospital Acquired Conditions (HAC) and Patient Safety Indicators (PSI).
• Meets revenue cycle goals (Key Performance Indicators (KPIs) and Productivity Standards).
• Communicates with HIM coding staff to resolve discrepancies
Communication
• Ensures the appropriate dissemination and communication of all regulation, policy, and guideline changes to appropriate stakeholders.
• Participates in and represents CDI at local and system level by participating in interdisciplinary leadership meetings on quality, mortality and harm, and other HHC initiatives related to CDI.
• Presents education on topics related to clinical documentation integrity in all care settings to all service lines.
Other
• Participates in and contributes to CDI Leadership and Coding/CDI Meetings.
• Works on general or special assignments and other duties and may lead specialized projects as assigned.
• Abides by The Ethical Standards for Clinical Documentation Improvement (CDI) Professionals as set forth by the American Health Information Management Association.
Projects
• Participates in other assignments and special projects, may lead projects as assigned.
Working Relationships:
Job Title of Individual(s) Reports To: Clinical Documentation Manager
# Workers Responsible For:
• Direct Reports: 2-25
• In-Direct Reports: 0
Nature of Supervision:
• Accountable for ensuring that the Regional/Hospital CDS team consistently meets quality and quantity expectations.
• Advances the CDS team by influencing desired H3W Leadership Behaviors
• Abides by HHC's Guiding Principles of Safety, Integrity, Caring and Excellence
• Fosters an environment of teamwork and service excellence for the Clinical Documentation team.
• Leads and manages multiple concurrent projects, prioritizes tasks and adapts to frequent changes in priorities.
• Recognizes necessary changes in priority of tasks and allocation of resources, and brings them to the attention of leadership, as required.
Internal:
• Direct supervision of CDS staff. Strong working relationships with medical staff, HIM Coding staff, quality management, leadership teams and others as needed.
Qualifications:
Education:
• Bachelor degree or equivalent experience
Experience
• Minimum: Registered Nurse (RN) with 3-5 years CDS experience
• Preferred:
• RN with 3-5 years CDS experience
• Previous management experience preferred
Licensure, Certification, Registration
• RN and/or Certified Coding Specialist (CCS)
And
• Certified Clinical Documentation Specialist (CCDS) certification or Certified Clinical Documentation Professional (CDIP)
Language Skills
• Strong written and verbal communication skills.
• Solid analytical capabilities.
• Good organizational skills.
• Critical thinking, problem solving and deductive reasoning skills
Knowledge, Skills and Ability Requirements:
• Excellent organizational, writing and interpersonal skills
• Understanding and support of clinical documentation integrity and strategies for improvement
• Knowledge of Pathophysiology and Disease Process
• Working knowledge of clinical information
• Extensive ability to understand and communicate the impact of CC/MCC's and other variables on the assignment of the various DRG methodologies.
• Specialized understanding and knowledge of ICD-10-CM diagnosis and ICD-10-PCS procedure codes.
• Strong analytical capabilities.
• Excellent organizational skills, strong critical thinking, problem solving and deductive reasoning skills.
• Strong electronic medical record, encoder and/or Computer Assistant Coding (CAC) skills.
We take great care of careers:
With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge - helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.