Program Integrity Director Jobs in West Chester, PA

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.  

The Service Area Director, Clinical Documentation Integrity, directs the activities of the Clinical Documentation Integrity (CDI) department. The selected candidate is responsible for providing CDI program oversight and day-to-day implementation of processes related to the concurrent review of the clinical documentation in the inpatient medical record of Optum Insight Client patients (Allina, ProHealth and Queens' Health) at multiple hospitals.  This includes, but is not limited to, overall responsibility for the planning, administration, control and quality management of the CDI Department activities in addition to regular reporting of department progress and initiatives to hospital leadership.

This position collaborates with 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.  This position utilizes clinical expertise and clinical documentation improvement practices and facility specific tools for best practice and compliance with the mission/philosophy, standards, goals and core values of Optum.  The Service Area Director of CDI does not have patient care duties, does not have direct patient interactions, and has no role relative to patient care.

The Clinical Documentation Integrity (CDI) Director to lead multi-site CDI programs across hospital systems in Pennsylvania, Massachusetts, and New York.
 

This is a high-impact leadership role responsible for driving CDI program performance, partnering with hospital executives, and leading distributed clinical teams across multiple facilities.

The CDI Service Area Director is involved in the education of all phases of the Clinical Documentation Improvement process across a service area. Provides ongoing Clinical Documentation Improvement education for physicians & new staff and new initiatives or identified areas of knowledge deficit.  Tracks and trends program compliance to determine areas of focus for educational opportunities.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

What You'll Do

• Lead CDI operations across multiple hospital systems (PA, MA, NY)
• Manage ~15 FTEs, including direct and indirect reports
• Drive performance through KPIs, analytics, and reporting
• Partner with hospital leadership (CMO, CFO, physicians) to improve documentation quality
• Lead client-facing discussions, presentations, and escalations
• Develop and execute CDI education initiatives for providers and staff
• Oversee staffing, workflows, compliance, and program outcomes

Primary Responsibilities:

• Operations, business, financial, and human resource needs of the CDI department
• Plan daily operations of the department in conjunction with the AVP of CDI and participate in development of objectives to meet KPI's
• Direct and maintains adequate staffing and workflow to meet CDI needs
• Monitor various reports and productivity to ensure that production standards and objectives are met in areas of responsibility
• Lead the CDI program as demonstrated by assuming accountability for the ongoing success of the Clinical Documentation Program. Monitors CDI program and communicates with appropriate facility leadership regarding CDI key performance indicators (KPIs), and identifies and implements process changes to maintain and improve KPIs
• Engage and consult with Physician Advisor and/or CMO to resolve provider issues regarding answering clarifications and participation in the clinical documentation improvement process
• Serves as a resource to Physicians / Case Managers and other key professional staff in matters relating to clinical documentation improvement & ICD-10
• Works with medical records, quality, finance, and physician groups to develop systems to facilitate complete documentation for data reporting purposes
• Develops and monitors strategic operating goals, objectives and budget; and reports operational performance, justification and/or corrective action
• Develops and manages direct reports; and oversees the development and management of indirect reports
• Builds and maintains productive inter/intra departmental and vendor work relationships to optimize operations
• Oversees compliance with government and agency regulations
  Performs related duties, as required
• Provide ongoing Clinical Documentation Improvement education for providers & new staff and new initiatives or identified areas of knowledge deficit.  Track and trend program compliance to determine areas of focus for educational opportunities
• This position will require frequent interaction with hospital leadership, clinical teams, Quality, Care Coordination, and other departments across multiple facilities and multiple client accounts
• Manage multiple projects simultaneously, manage cross-functional teams, and drive strategic initiatives
• Design and implement education programs which provide education for CDI staff
  • Develop and conduct ongoing CDI education for new staff
  • Participate in ongoing education of staff
• Communicate information effectively
  • Monthly reporting of CDI program progress/operations to hospital leadership
  • Responding to questions, concerns and requests promptly
  • Serving as a resource regarding policies/procedures/practices
• Identify areas of improvement/education through data collection, analysis, and reports.  Participate on committees and conduct studies as necessary to demonstrate improvement in clinical documentation processes
• Interview, hire, provide leadership, counseling, training for employees in areas of responsibility
• Ensure new employees are oriented and trained in all job functions.
• Perform counseling both verbal and written for employees requiring additional assistance as evidenced by communication in the personnel file
• Provide consultation to providers and other clinical professionals, and leads implementation of changes that result in improvements in the patient care team's ability to provide appropriate and timely treatment, communication regarding the patient's condition, patient's response to treatment, severity of illness, risk of mortality and treatment complexity

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:

• RN, MD/D FMG
• CCDS or CDIP  
• 4 years CDI experience (acute inpatient)
• 2 years leadership experience (team program oversight)
• Advanced analytics and reporting experience (Excel, dashboards)
• Able to travel 30-40% to support multiple hospitals & client sites

Preferred Qualifications:

• CCS certification
• Director-level CDI experience
• Experience in multi-client / multi-hospital environments
• Solid analytics & KPI ownership experience

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

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. The salary for this role will range from $112,700 - $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.