Remote Optum Utilization Review Jobs in Colorado

As our Revenue Cycle CDI Specialist, you will serve as a vital clinical partner dedicated to enhancing the accuracy and integrity of inpatient medical records. You will play a pivotal role in ensuring that provider documentation effectively captures the severity of illness, expected risk of mortality, and complexity of care for every patient. By bridging the gap between clinical teams, quality departments, and coding professionals, you will drive excellence in DRG assignment and support the overall financial health of CommonSpirit Health through compliant, high-quality documentation practices.

Every day you will conduct thorough medical record reviews for your assigned patient population, performing initial evaluations within 24–48 hours of admission and executing systematic follow-ups to maintain precise working DRG assignments. You will utilize your clinical expertise to formulate compliant provider queries that clarify missing or conflicting information while adhering to strict AHIMA and ACDIS guidelines. Additionally, you will serve as a front-line educator, providing guidance to physicians, nursing staff, and allied health practitioners to ensure continuous improvement in clinical documentation standards.

To be successful in this role, you will need a deep understanding of Official Coding and Reporting Guidelines, AHA Coding Clinics, and current CMS directives. You must be a proactive collaborator who excels at building professional relationships with HIM coding teams and providing constructive feedback to providers. Your ability to translate complex clinical data into actionable documentation, combined with your comfort in presenting to diverse groups and troubleshooting technical issues in a remote environment, will be key to your success and to the achievement of our enterprise-wide clinical documentation goals.

• Perform timely initial and follow-up medical record reviews to ensure accurate DRG assignment, risk of mortality, and severity of illness.
• Author and manage compliant provider queries to resolve documentation gaps, adhering to national AHIMA and ACDIS standards.
• Educate multi-disciplinary care teams on documentation best practices to ensure clear and comprehensive clinical representation.
• Collaborate closely with HIM Coding Professionals to facilitate seamless documentation-to-coding workflows and DRG reconciliation.
• Maintain expert-level knowledge of evolving coding guidelines, CMS directives, and industry-wide CDI trends.
• Demonstrate strong oral communication and presentation skills to lead educational sessions and engage effectively with clinical leadership.

Required 

• Bachelor of Nursing and/or Bachelor’s degree in Nursing, or HIM
• Two (2) years’ acute care hospital clinical CDI experience 
• Two (2) years’ experience inpatient coding auditor
• Certified Coding Specialist (CCS)
• Registered Nurse:XX (RN:XX)

Preferred

• CAC experience (Computer Assistant Coding)
• Experience with various encoder and EMR systems (Optum eCAC, Solventum, EPIC, Cerner, Meditech)
• Registered Health Information Technician (RHIT)
• Certified Cardiac Device Specialist (CCDS)
• Clinical Documentation Improvement Professional (CDIP)
• Certified Coding Specialist (CCS)

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.

Required 

• Bachelor of Nursing and/or Bachelor’s degree in Nursing, or HIM
• Two (2) years’ acute care hospital clinical CDI experience 
• Two (2) years’ experience inpatient coding auditor
• Certified Coding Specialist (CCS)
• Registered Nurse:XX (RN:XX)

Preferred

• CAC experience (Computer Assistant Coding)
• Experience with various encoder and EMR systems (Optum eCAC, Solventum, EPIC, Cerner, Meditech)
• Registered Health Information Technician (RHIT)
• Certified Cardiac Device Specialist (CCDS)
• Clinical Documentation Improvement Professional (CDIP)
• Certified Coding Specialist (CCS)