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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Senior Clinical Practice Performance physician (MD, DO), nurse practitioner (NP) or physician assistant (PA) will apply clinical expertise and knowledge of documentation guidelines to ensure quality of clinical documentation across Optum Health. This position will collaborate with a multidisciplinary team of clinicians, operations, and coding professionals as a member of the Clinical Documentation Review team within Optum Clinical Excellence. This position will provide support to Optum clinicians and leadership to promote excellence in clinical documentation.

This position is Monday - Friday and reports to the Associate Director, Clinical Documentation Review, in Optum Clinical Excellence.

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

Primary Responsibilities:

• Performs clinical chart reviews to ensure documentation accuracy by applying established clinical criteria for the diagnosing of medical conditions
• Reviews reported diagnoses for clinical validation within the visit note or medical record
• Identifies documentation errors and opportunities for documentation improvement and documents review findings in a standardized form/audit tool
• Collaborates with team members as part of the clinical review process to promote accuracy and consistency of results
• Meets accuracy and productivity metrics to ensure team achieves established departmental goals
• Communicates with Optum leaders to address documentation issues and trends 
• Provides recommendations for education to Optum Health businesses and clinicians to improve documentation
• Actively participates in all department meetings as scheduled
• Performs related duties, as required

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:

• Active unrestricted state license to practice in respective clinical field
• Board certification in respective clinical field, for example:
  
  • M.D. or D.O. with completed residency and board certification 
  • Nurse Practitioner national certification in Adult, Adult-Geriatric, Family or Acute 
  • Certification by the National Commission on Certification of Physician Assistants (NCCPA)
• 5+ years of clinical practice experience
• Experience in ICD-10 coding and documentation requirements
• Technical experience using different EMR systems (e.g., EPIC, eClinical Works, Touchworks)
• Solid clinical background in evidence-based medicine including chronic disease management and prevention
• Proficiency in MS applications (Excel, Outlook, Teams, PowerPoint & Word)
• Proven ability to perform a comprehensive chart review of multiple medical records per day
• Proven flexible and able to adapt to change based on departmental needs
• Proven excellent analytical and critical thinking skills 
• Proven excellent verbal/written communication and people skills
• Proven ability to work independently and as part of a team in a fast-paced environment
• Proven ability to travel for on-site meetings 1-2 times per year

Preferred Qualifications:

• Coding certification from AAPC or AHIMA professional coding association or additional coursework/experience in coding and/or Risk Adjustment
• Experience working with Medicare Advantage programs and CMS Risk Adjustment model
• Work experience in clinical documentation review or in a clinical quality program
• Experience developing and delivering clinical education and training 

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

California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $88,000 to $173,200 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

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.

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.