APC or MD Clinician Reviewer

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 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.

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:

• Board certification in respective clinical field, for example:
  • Nurse Practitioner national certification in Adult, Adult-Geriatric, Family or Acute
  • Certification by the National Commission on Certification of Physician Assistants (NCCPA)
  • Active unrestricted state license to practice in respective clinical field
• 5+ years of clinical practice experience
• Demonstrated solid clinical background in evidence-based medicine including chronic disease management and prevention
• Experience in ICD-10 coding and documentation requirements
• Ability to perform a comprehensive chart review of multiple medical records per day
• Technical experience using different EMR systems (e.g., EPIC, eClinical Works, Touchworks)
• Proficiency in MS applications (Excel, Outlook, Teams, PowerPoint & Word)
• Ability to be 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
• Ability to work independently and as part of a team in a fast-paced environment
• 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
• Bilingual (English/Spanish)

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 $89,900 to $140,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.