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Nurse - Clinical Educator - Hartford, CT - $3000 Sign On Bonus for External Candidates

Employer
UnitedHealth Group
Location
Avon, CT
Closing date
Jan 23, 2021

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Profession
Nurse
Specialty
Medical Management
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)

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 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.

Primary Responsibilities:


    Work collaboratively with Clinical and technical resources to ensure quality programs are effective and reporting is completed to meet deadlines requirements
    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

    This is a field-based position.

    The regional Office (home base) is located in Farmington, CT

    Position requires local travel throughout CT (no overnight travel required)

    $3,000 sign on bonus for external candidates

    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:


      Current, unrestricted RN license for the state of Connecticut
      Three years of clinical practice experience, working in a provider setting
      Experience with Microsoft applications such as Word, Outlook, Excel and PowerPoint
      Ability to travel within Connecticut offices to conduct on-site education sessions

      Preferred Qualifications:


        BSN or MSN preferred
        Five years of clinical practice experience, working in a provider setting
        Two 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 / inpatient billing processes
        Solid understanding of coding principles preferred
        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)

        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, Connecticut Risk Adjustment, CPC, CRC

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