UnitedHealth Group Inc
RN Clinical Coding Nurse Consultant WellMed San Antonio Texas - Clinic
UnitedHealth Group Inc, San Antonio, Texas, United States, 78208
Registered Nurse (RN) - Clinical Coding Nurse Consultant
WellMed, part of the Optum family of businesses, is seeking a Registered Nurse to join our team in San Antonio, TX. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone. Here, you'll work alongside talented peers in a collaborative environment guided by diversity and inclusion while driving towards the Quadruple Aim.The Sr. Clinical Coding Nurse Consultant will drive consistent, efficient processes and share best practices in a collaborative effort with Providers and Market Team, designed to facilitate achievement of goals set for HCC Ratio, HCC Covered Ratio, and HCC Percent Covered. This position will work collaboratively with each regional/market team and their leadership in a matrix relationship. You will provide direction and guidance to Medical Coding Analysts and cross-functional team members within your respective Markets pertaining to Risk Adjustment.Primary Responsibilities:
Develop and implement market business plans to motivate providers to engage in improving Risk Adjustment metrics.Provide analytical interpretation of Risk Adjustment reporting including Executive Summaries, HCC Ratio, Disagree and Resolution rates, and FaxBack reporting to plan and provider groups.Act as Subject Matter Expert (SME) for all Risk Adjustment related activities within assigned market(s).Assist in developing training and analytical materials for Risk Adjustment.Oversee DataRAP training and education delivery for Mega Groups via Provider education sessions and Physician Business Meetings.Lead business review meetings related to Risk Adjustment activities.Analyze and evaluate provider group structure and operations to identify effective approaches related to Risk Adjustment.Develop solution-based, user-friendly initiatives to support practice success.Oversee market-specific chart retrieval and review of records.Work with DataRAP Senior Leadership on identified special projects.This is a hybrid/office-based position located near Interstate Highway I-10 West, near West Frontage Road just past The Rim Shopping Center/Ferrari Dealership, 78257, with 25% travel as determined by the business.Required Qualifications:
Bachelor's degree in Nursing (or equivalent experience) and current RN license in good standing.CPC certification or proof that certification has been obtained within 9 months from date of hire.5+ years of associated nursing experience within the healthcare industry.1+ years of familiarization with ICD10 codes.Solid knowledge of the Medicare market, products, and competitors.Proven ability and willingness to travel as determined by business needs.Preferred Qualifications:
Undergraduate degree.Experience in managed care working with network and provider relations.Additional medical chart review experience.Knowledge of CMS HCC Model and Guidelines along with ICD 10 Guidelines.Pay
Average Texas Staff Position Pay: $39.79/hour.The average salary for a Clinic is 12% lower than the US average of $44. Estimate based on Bureau of Labor Statistics data.Diversity creates a healthier atmosphere: OptumCare 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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WellMed, part of the Optum family of businesses, is seeking a Registered Nurse to join our team in San Antonio, TX. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone. Here, you'll work alongside talented peers in a collaborative environment guided by diversity and inclusion while driving towards the Quadruple Aim.The Sr. Clinical Coding Nurse Consultant will drive consistent, efficient processes and share best practices in a collaborative effort with Providers and Market Team, designed to facilitate achievement of goals set for HCC Ratio, HCC Covered Ratio, and HCC Percent Covered. This position will work collaboratively with each regional/market team and their leadership in a matrix relationship. You will provide direction and guidance to Medical Coding Analysts and cross-functional team members within your respective Markets pertaining to Risk Adjustment.Primary Responsibilities:
Develop and implement market business plans to motivate providers to engage in improving Risk Adjustment metrics.Provide analytical interpretation of Risk Adjustment reporting including Executive Summaries, HCC Ratio, Disagree and Resolution rates, and FaxBack reporting to plan and provider groups.Act as Subject Matter Expert (SME) for all Risk Adjustment related activities within assigned market(s).Assist in developing training and analytical materials for Risk Adjustment.Oversee DataRAP training and education delivery for Mega Groups via Provider education sessions and Physician Business Meetings.Lead business review meetings related to Risk Adjustment activities.Analyze and evaluate provider group structure and operations to identify effective approaches related to Risk Adjustment.Develop solution-based, user-friendly initiatives to support practice success.Oversee market-specific chart retrieval and review of records.Work with DataRAP Senior Leadership on identified special projects.This is a hybrid/office-based position located near Interstate Highway I-10 West, near West Frontage Road just past The Rim Shopping Center/Ferrari Dealership, 78257, with 25% travel as determined by the business.Required Qualifications:
Bachelor's degree in Nursing (or equivalent experience) and current RN license in good standing.CPC certification or proof that certification has been obtained within 9 months from date of hire.5+ years of associated nursing experience within the healthcare industry.1+ years of familiarization with ICD10 codes.Solid knowledge of the Medicare market, products, and competitors.Proven ability and willingness to travel as determined by business needs.Preferred Qualifications:
Undergraduate degree.Experience in managed care working with network and provider relations.Additional medical chart review experience.Knowledge of CMS HCC Model and Guidelines along with ICD 10 Guidelines.Pay
Average Texas Staff Position Pay: $39.79/hour.The average salary for a Clinic is 12% lower than the US average of $44. Estimate based on Bureau of Labor Statistics data.Diversity creates a healthier atmosphere: OptumCare 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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