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Job 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. 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. The existing quality programs at Optum 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.
- Department: Risk Adjustment
- Location: Hybrid, supporting locations around Chappaqua, New York
- Schedule: Full time, 40 hours weekly, Monday - Friday, hours between 8AM – 5PM
- 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
- 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
- Ability to travel within New York offices to conduct on-site education sessions
- BSN or MSN
- CPC or CRC certification
- Experience with EMR systems (NextGen / EPIC)
About the Company
UnitedHealth Group
Minnetonka, MN, United States
UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions worldwide. We are... Read more