Opportunities at WellMed , part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind *Caring. Connecting. Growing together.  *

　　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. The Sr. Clinical Coding Nurse Consultant will drive Risk Adjustment improvement initiatives, develop recommendations for Risk Adjustment remediation plans and create tools and databases to capture relevant data for assigned markets to achieve corporate and market specific Risk Adjustment goals and initiatives. This position will work collaboratively with each regional/market team and their leadership in a matrix relationship. This position will provide direction and guidance to Medical Coding Analysts, as well as cross functional team members within their 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

　　Subject Matter Expert (SME) for all Risk Adjustment related activities within their assigned market(s) working within a matrix relationship which includes DataRAP operations and Regional/Market operations

　　Assist in developing of training and analytical materials for Risk Adjustment

　　Oversee DataRAP training and education delivery for Mega Groups via Provider education sessions and Physician Business Meetings / JOCs

　　Lead Weekly, Monthly, Bi-monthly, Quarterly, and/or Annual Business Review meetings related to Risk Adjustment activities which summarize provider group performance and market performance as requested by or required by Market leadership

　　Analyze and evaluate provider group structure and characteristics, provider group/provider office operations and personnel to identify the most effective approaches and strategies related to Risk Adjustment

　　Analyze Provider and Group performance regarding Risk Adjustment and Focus on Care (FOC) to determine areas of focus or improvement opportunities

　　Develop solution-based, user friendly initiatives to support practice success

　　Oversee market specific chart retrieval and review of PCP, Hospital, and Specialist records

　　Work with DataRAP Senior Leadership on identified special projects

　　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:

　　Bachelor’s degree in Nursing required (Associate’s degree or Nursing diploma from accredited nursing school with 2+ years of additional experience may be substituted in lieu of a bachelor’s degree) and current RN license in good standing

　　CPC certification or proof that certification has been obtained within 9 months from hire date from the American Academy of Professional Coders

　　3+ years associated business experience with health care industry

　　1+ years of ICD-9, ICD10 coding experience

　　Professional experience persuading changes in behavior

　　Knowledge of CMS HCC Model and Guidelines along with ICD 10 Guidelines

　　Solid knowledge of the Medicare market, products and competitors

　　Knowledge base of clinical standards of care and preventative health measures

　　Proven ability and willingness to travel (locally and non-locally) as determined by business needs

　　Preferred Qualifications:

　　Undergraduate degree

　　Experience in managed care working with network and provider relations

　　Additional Medical chart review experience

　　Medical/clinical background

　　Proven solid presentation skills and relationship building skills with clinical/non-clinical personnel

　　Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels

　　Proven ability to solve process problems crossing multiple functional areas and business units

　　Proven solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action

　　Proven good business acumen, especially as it relates to Medicare

　　MS Office Suite, proven moderate to advanced EXCEL and PowerPoint skills

　　Physical & Mental Requirements:

　　Ability to push or pull heavy objects using pounds of force

　　Ability to stand for extended periods of time

　　Ability to properly drive and operate a company vehicle

　　At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves 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.