Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
Responsible clinical education and training to contracted Independent Practice Association (IPA) providers and staff in the OptumCare New Mexico (OCNM) Risk Bearing Entity (RBE). Monitors and reports on Key Performance Indicators (KPIs) for OCNM in the context of the OptumCare Mountain West Region (MWR) as well as KPIs within their region designed to ensure uniform and consistent processes related to coding, HCC risk adjustment activities, HEDIS measures, and other CMS STARs measures.
The Clinical Educator will work with the Medical Director Network Performance, Network Management team, and Medical Coding Services team to monitor the performance of physician Chart Reviews and to provide feedback to contracted physicians on coding opportunities for inferred, embedded, out of date, inaccurate, omitted, or newly identified missed diagnoses, including education and training to optimize thorough and accurate coding and documentation. The Clinical Educator is expected to maintain current knowledge of and expertise in Centers for Medicaid and Medicare Services (CMS) changes in the Medicare risk adjustment model, STARs, and or other documentation requirements.
The Clinical Educator works collaboratively with the Optum employed group Clinical Educator, Medical Coding Services team, the Risk Adjustment program director, other Clinical Educators, group administrators and clinicians, and other external and internal stakeholders to optimize patient care documentation and coding completeness.
If you are located in Albuquerque or Santa Fe, NM, you will have the flexibility to telecommute* as you take on some tough challenges.
- Serve as a resource on proper coding and documentation for the OCNM contracted IPA practices and OCNM and MWR teams
- Provide coding and documentation education and training to contracted physicians and advanced practice clinicians (APCs) and employed physicians and APCs as requested
- As required develop and implement processes and procedures to ensure compliance with all CMS coding and documentation requirements
- Perform and monitor ongoing chart review process to ensure optimal coding and documentation in compliance with CMS requirements
- Work collaboratively with Medical Coding team to support the Physician Chart Review process
- Support Medical Director Network Performance and the OCNM Network Management team to achieve goals for risk adjustment, HEDIS and STARs metrics
- Attend network and clinic site meetings to present material on coding and documentation
- Review charts to identify and disseminate opportunities to improve accuracy and completeness of coding and documentation
- Attend courses as needed to improve knowledge of coding, documentation, and STARs requirements
- Meet regularly with appropriate OCNM and MWR teams to provide updates on activities related to OptumCare NM RBE IPA business
- Demonstrate consistently behaviors and communication skills that align with and support Optum’s commitment to superior customer service with focus on quality, care, and concern for all external and internal customers
- Design and implement training and education programs to ensure all diagnosed codes and conditions are properly supported by appropriate documentation in patient chart per CMS requirements
- Work with OCNM Medical Director Network Performance and Network Management team to identify, develop, and implement operational and clinical best practices to optimize patient visits, re-evaluation rates and accurate and proper coding and disseminate to IPA clinicians and support staff
- Attend and participate in local, regional, and corporate coding and documentation meetings to share best practices
- Attend courses to maintain and improve expertise in risk adjustment, coding, documentation, and STARs requirements
- Complete annual compliance training on HIPAA / Privacy / Confidentiality / Non-Discrimination / Harassment / Integrity Statement and certify completion thereof, and ensure confidentiality of patient information following HIPAA requirements and company policy
- Complete all necessary training to meet ongoing licensure and job requirements or as required by company policies, Div. of Occupational Safety & Health (DOSH), OSHA, L&I and other state and federal regulations
- Use, protect, and disclose Optum’s patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
- Performs additional duties as assigned to support OCNM business objectives with regards to the contracted RBE IPA network
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.
- RN degree
- Current Nursing License in New Mexico or Nursing Compact state or unrestricted license to practice medicine in New Mexico
- 2+ years of clinical experience with direct patient care
- Good working knowledge of Microsoft Word, Excel, PowerPoint and various EMR platforms
- Ability to work independently and use computers and various modes of communication
- Ability to develop positive interaction with all external and internal stakeholders and customers and develop trusted relationships in order to improve the quality of coding and documentation to support optimal patient care outcomes
- Ability to travel independently to IPA practice and other sites
- If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
- Advanced degree such as MD, DO, NP, or PA
- Certification in Coding
- Experience in education and clinical training of clinician and practitioners
- Experience with Managed Care health plans and chart review for HEDIS or other audit function including review and information abstraction from Electronic Medical Records (EMRs)
- Excellent verbal and written communication skills
- Ability to work collaborative and effectively with teammates and clinicians
- Self-starter with strong motivation and excellent analytical skills
- Communicate effectively with external and internal stakeholders and customers
- Kneeling / Crouching
- Lifting light to 10lbs
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
Job keywords: Clinical Educator, Registered Nurse, RN, Direct Patient Care, EMR, IPA, Albuquerque, Santa Fe, NM, New Mexico