Description

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

The Clinical Documentation Integrity (CDI) Specialist is responsible for reviewing clinical documentation to ensure accuracy, completeness, and compliance with regulatory and coding requirements. This role collaborates with providers, coding, quality, and revenue cycle teams to support accurate severity of illness (SOI), risk of mortality (ROM), quality metrics, and reimbursement.

This position is fully remote and requires strong clinical expertise, excellent communication skills, and a solid understanding of compliance and documentation standards.

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

Primary Responsibilities:

Clinical Documentation Review:

• Conduct concurrent and/or retrospective reviews of inpatient and/or outpatient medical records
• Identify documentation gaps, inconsistencies, or clinical indicators requiring clarification
• Ensure documentation supports accurate ICD 10 CM/PCS coding, DRG assignment, and risk adjustment

Provider Queries & Communication:

• Initiate compliant, concise provider queries in accordance with AHIMA/ACDIS guidelines
• Educate providers on documentation best practices to improve clarity and specificity
• Serve as a clinical resource for documentation improvement initiatives

Quality & Compliance:

• Support quality reporting measures (e.g., HCCs, PSI, HAC, mortality metrics)
• Ensure compliance with federal and state regulations, payer requirements, and internal policies
• Maintain audit ready documentation practices

Collaboration & Reporting:

• Collaborate with coding, case management, utilization review, finance, and quality teams
• Track CDI metrics such as query response rates, case mix index (CMI), and documentation impact
• Participate in team meetings, audits, and continuous process improvement efforts

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 RN, MD, DO, or International Medical Graduate (IMG) license/credential (as applicable)
• 2+ years of recent clinical and/or acute care experience
• 1+ years CDI experience
• Advanced knowledge of:
  • ICD 10 CM diagnosis coding
  • MS DRGs and/or APR DRGs
  • SOI/ROM, CMI, and quality indicators
• Familiarity with EHR systems (Cerner)
• Knowledge of AHIMA/ACDIS compliant query practices

Preferred Qualifications:

• CDI certification:
  • CCDS (Certified Clinical Documentation Specialist)
  • CDIP (Certified Documentation Improvement Practitioner)
• Experience with:
  • Risk adjustment (HCCs)
  • Medicare Advantage or value based care models
  • Payer based or vendor CDI programs
• Prior remote CDI experience
• Inpatient CDI experience
• Proficiency in Microsoft Office, CDI software, and other EHR platforms

Skills & Competencies:

• Excellent written and verbal communication
• Solid clinical judgment and analytical skills
• Time management and ability to meet productivity targets in a remote environment

Work Environment:

• Fully remote (must have secure, high speed internet)
• Standard business hours with flexibility depending on program needs
• HIPAA compliant home workspace

*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 $60,200 to $107,400 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.