Work collaboratively with Clinical and technical resources to ensure quality programs are effective and reporting is completed to meet deadlines requirements Act as a Subject Matter Expert on clinical documentation and risk adjustment Plan, conduct and coordinate all aspects of MRA (Medicare Risk Adjustment) process evaluation and education to internal partners Communicating a comprehensive understanding of Medicare Risk Adjustment, Documentation & Coding guidelines Analyze reports to identify a... more details
Opportunities with Optum in the Tri-State region (formerly CareMount Medical, ProHEALTH New York and Riverside Medical Group). Come make a difference in the lives of people who turn to us for care at one of our hundreds of locations across New York, New Jersey and Connecticut. Work with state-of-the-art technology and brilliant co-workers who share your passion for helping people feel their best. Join a dynamic health care organization and discover the meaning behind Caring. Connecting. Growing together.
Position Details:
- Department: Risk Adjustment
- Location: Telecommuter, schedule aligned with Eastern time zone, must possess an active, unrestricted NY license for the state of New York
- Schedule: Full time, 40 hours weekly, Monday - Friday, hours between 8AM 5PM
The Nurse Quality/Clinical Educator (Risk Adjustment) will be responsible for the day to day management of Quality programs, initiatives, and reporting as well as for Risk Adjustment activities for Optum Care Network of Connecticut providers. The existing quality programs at Optum Care CT IPA are recognized as the best in the state by many business partners. In the Quality role, you would provide support to the teams implementing and reporting on these programs. The main risk initiatives for the Clinical Educator will be provider education, chart review, and ensuring accurate coding and documentation across the organization.
If you currently possess an active and unrestricted RN license for state of NY, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
- Work collaboratively with Clinical and technical resources to ensure quality programs are effective and reporting is completed to meet deadlines requirements
- Act as a Subject Matter Expert on clinical documentation and risk adjustment
- Plan, conduct and coordinate all aspects of MRA (Medicare Risk Adjustment) process evaluation and education to internal partners
- Communicating a comprehensive understanding of Medicare Risk Adjustment, Documentation & Coding guidelines
- Analyze reports to identify and report documentation/coding trends to create opportunities for improvement with internal partners
- Ensure provider documentation and diagnostic code selections are appropriate and recommend improvements as necessary
- Continually assess the knowledge and appropriate application of ICD-10 documentation and coding guidelines
- Leverage reporting benchmarks and MRA success measures to prioritize efforts
- Demonstrate a professional and effective face to face communication style and address issues as they arise
- Act as a Subject matter expert on Risk platforms ?
Youll 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:
- Current, unrestricted RN license for the state of New York
- 3+ years of clinical practice experience working in an acute setting
- Experience with Microsoft applications such as Word, Outlook, Excel and PowerPoint
- Designated workspace and access to high speed internet service
Preferred Qualifications:
- BSN or MSN
- CPC or CRC certification
- Experience with EMR systems (NextGen / EPIC)
*All employees working remotely will be required to adhere to UnitedHealth Groups Telecommuter Policy
New York Residents Only: The hourly range for New York residents is $23.22 to $45.43 per hour. 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, youll find a far-reaching choice of benefits and incentives.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves 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.
