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) Clinical Performance is charged with effectively implementing, monitoring, and executing on programs related to risk adjustment, driving affordability, and clinical quality activities across all lines of business for OptumCare a $9 billion a year organization, touching over 9 million patients, 80 payers, and 22,000 providers. Enterprise Clinical Performance provides support to all markets served by OptumCare. This position reviews daily census reports across multiple regions and care delivery organizations (CDOs) to identify long length of stay (LLOS) patients and review clinical information to forecast the likely DRG. The Clinical Documentation Improvement Consultant (CDIC) collaborates with claims departments and other healthcare team members to obtain current billed charges, reviews the work of these others, and input into the CMS Pricer to identify potential outlier patients. The CDIC will serve as an educational resource for lead and front-line hospitalists. This role will develop and implement innovative approaches in continuous process improvements with the opportunity to own and manage the entire process. This consultant is sought out as an expert. The Clinical Document Improvement Specialist (CDIC) is primarily responsible for supporting hospital unit cost management at Diagnosis-Related Group (DRG) facilities. The CDIC will carry out this responsibility by providing the following: • Proactively identify potential outlier patients at DRG hospitals • Support documentation improvement efforts for attending physicians, including recommendations for how to respond to hospital query forms • Facilitate workflows to improve capture of post-acute care transitions The CDIC must be able to manage multiple time-sensitive queries simultaneously and provide timely feedback to lead hospitalists with little oversight or instruction. The CDIC will serve as leader/mentor as an educational resource for lead and front-line hospitalists. This role will develop and implement continuous process improvements with the opportunity to own and manage the entire process. This position does not have patient care duties, does not have direct patient interactions, and has no role relative to patient care. Primary Responsibilities: • Anticipates needs and proactively develops solutions to meet them • Drives hospital unit cost management at Diagnosis-Related Group (DRG) facilities • Identifies potential outlier patients at DRG hospitals • Provides recommendations to hospitalist physicians for how to appropriately respond to hospital query forms • Supports capture of patients eligible for post-acute care transitions • Reviews daily census reports across multiple regions and CDOs • Identifies target patients and reviews clinical information • Forecasts DRG based on available information, this may be a complex conceptual analysis • Works with claims department and/or develops independent workflow to plug inputs into CMS Pricer • Coordinates with claims department teammates on obtaining current billed charges when applicable • Serves as a key resource and plans for additional needed resources on complex and or critical issues and provides explanations and information to others on difficult issues in development of innovative solutions • Provides structured, timely feedback to lead hospitalists on status of case relative to outlier status and projected outlier daily charges • Manages multiple time-sensitive queries simultaneously and tracks outcomes • Identifies solutions to non-standard, less structured, and more complex requests and problems • Translates concepts into practice • After review of work completed by others, develops recommendations and implements continuous process improvements with authority to authorize deviations from a standard • Serves as educational resource for lead and front-line hospitalists • Opportunity to own and manage entire process / expand scope and value of operation, and motivate and inspire other team members 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. Qualifications - External Required Qualifications: • Undergraduate degree or equivalent experience • 5 + years of experience as a Clinical Documentation Improvement Specialist • 5 + year of experience communicating and working closely with Physicians • Basic proficiency using a PC in a Windows environment, including Micro