RN Clinical Educator (Risk Adjustment- HCC Coding) - Hartford, CT
Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)
If you want to get way ahead in your career, it makes sense to be with an organization that's way ahead of the curve. Formed in 1997, ProHealth Physicians has grown to become Connecticut’s leading primary care physician organization. With over 90 locations throughout the state of Connecticut, our family of primary care doctors and specialists care for more than 360,000 people statewide. In fact, ProHealth serves every county and provides roughly ten percent of the primary care delivered to patients in the state. We're leaders in thinking and in serving our communities. For instance, we're a C.M.S. approved Accountable Care Organization (ACO), covering over 30,000 Medicare patients associated with our community-based primary care providers. We're also nationally recognized as a NCQA Level III Medical Home. That kind of progressive leadership makes us perfect fit for OptumCare and UnitedHealth Group's expanding family of providers. This is a place where you can stay way ahead as you do your life's best work.(sm)
The RN 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 OptumCare CT IPA providers. The existing quality programs at OptumCare 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. OptumCare CT IPA is a dynamic group of physician-led medical groups across CT and is part of the larger OptumCare national entity. The position requires working with both local and national leaders. The IPA is a multi-payor contracting vehicle that currently holds Medicare Advantage risk contracts as well as shared savings contracts. Our goal is to provide the highest quality of care at an affordable cost for our members.
- Work collaboratively with Clinical and technical resources to ensure quality programs are effective and reporting is completed to meet deadlines requirements including but not limited to:
- Weekly touch points with IPA practice site resources to support Risk and Quality programs and reporting
- Collaborate with Senior Quality Liaison to identify and support 5 STAR quality targets for OptumCare CT IPA
- Manage and Monitor IPA programs participation and outcomes
- Monitor Quality and Risk platforms regularly to assist IPA practices in prioritizing outreach efforts
- Monitor and ensure that all users on the Quality platform are properly trained to complete supplemental data submissions – provide additional support/education on rejections as needed
- Act as a Subject Matter Expert on Quality platforms and supplemental data submissions
- Plan, conduct and coordinate all aspects of MRA (Medicare Risk Adjustment) process evaluation and education to internal and external partners, including but not limited to:
- Communicating a comprehensive understanding of Medicare Risk Adjustment, Documentation & Coding guidelines to both external/internal partners while ensuring compliance with regulatory.
- Analyze reports to identify and report documentation/coding trends in order to create opportunities for improvement with internal and external partners.
- Ensure provider documentation and diagnostic code selections are appropriate and recommend improvements as necessary, including system-view recommendations based on EMR scope
- 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 promptly in routine situations while building productive relationships and establish rapport
- Act as a Subject matter expert on Risk platforms
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.
- Current and unrestricted RN license for the state of Connecticut
- 3+ years of clinical practice experience, working in a provider setting
- Experience with Excel and PowerPoint
- Conducts education sessions with providers throughout the state of CT
- Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
- You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role
- 2+ years of experience working with Medicare Risk Adjustment (MRA)
- CPC or CRC certification
- Previous billing and coding OR medical office management experience
- Familiarity with outpatient and/or inpatient billing processes
- Strong understanding of coding principles
- Strong oral and written communication skills
- Excellent facilitation, consulting and delivery of complex content
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
**PLEASE NOTE** The sign on bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time, or per diem basis (“Internal Candidates”) are not eligible to receive a sign on bonus.
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.
Job Keywords: RN, Nurse Educator, HCC Coding, ProHealth, Nurse Coder, Coding Documentation, Healthcare, CT, Connecticut, Farmington, Primary Care, CDQI, Hartford, CT, Waterbury, CT, Risk Adjustment, CPC, CRC
CitizenshipStatus: Other Visa Accepted
Function: Clinical Administration
Division: ProHealth Physicians
Shift: Day Job