RN Clinical Coding Nurse Consultant WellMed San Antonio Texas
4 weeks ago
WellMed, part of the Optum family of businesses, is seeking a RN Clinical Coding Nurse Consultantto join our team in San Antonio, Texas. 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. At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while 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. Position Highlights & 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 In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors' offices. At WellMed our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone. 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. 25% position travel as determined by the business 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 (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 date of hire from the American Academy of Professional Coders * 5+ years associated nursing experience within health care industry * 1+ years of familiarization with ICD10 codes * Professional experience persuading changes in behavior * 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 * Knowledge of CMS HCC Model and Guidelines along with ICD 10 Guidelines * 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 presentation skills and relationship building skills with clinical/non-clinical personnel * 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 * Proven MS Office Suite, moderate to advanced EXCEL and PowerPoint skills 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.
-
San Antonio, Texas, United States UnitedHealth Group Inc Full timeRN Clinical Coding Nurse Consultant WellMed San Antonio TexasWellMed, part of the Optum family of businesses, is seeking a RN Clinical Coding Nurse Consultantto join our team in San Antonio, Texas. 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...
-
San Antonio, United States UnitedHealth Group Inc Full timeRN Clinical Coding Nurse Consultant WellMed San Antonio TexasWellMed, 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...
-
San Antonio, Texas, United States UnitedHealth Group Inc Full timeRN Clinical Coding Nurse Consultant WellMed San Antonio TexasWellMed, 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...
-
San Antonio, United States Optum Full timeWellMed, 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, youll be an integral part of our vision to make healthcare better for everyone.At Optum, youll have the...
-
Waring, TX, United States Optum Full timeWellMed, 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, youll be an integral part of our vision to make healthcare better for everyone.At Optum, youll have the...
-
San Antonio, United States Optum Full timeRegistered Nurse RN Home Health San Antonio Texas at Optum summary: The Registered Nurse (RN) in Home Health at WellMed provides skilled nursing services and coordinates home health care for patients in San Antonio, TX. Responsibilities include nursing assessments, developing care plans, delivering treatments, and ensuring compliance with healthcare...
-
San Antonio, United States Optum Full timeRegistered Nurse RN Home Health San Antonio Texas at Optum summary: The Registered Nurse RN in Home Health at WellMed provides skilled nursing services and coordinates home health care for assigned patients in the San Antonio area. This role includes developing and evaluating care plans, performing nursing assessments, and ensuring quality care delivery...
-
San Antonio, United States Optum Full timeRegistered Nurse RN Home Health San Antonio Texas at Optum summary: The Registered Nurse RN in Home Health at WellMed, part of Optum, provides skilled nursing services and coordinates home health care for patients in San Antonio, TX. This role involves thorough nursing assessments, development of care plans, and collaboration with physicians and caregivers...
-
San Antonio, United States Optum Full timeRegistered Nurse RN Home Health San Antonio Texas at Optum summary: The Registered Nurse (RN) in Home Health at WellMed provides skilled nursing services and coordinates care for patients in their homes. This role involves assessing patient needs, developing care plans, and collaborating with healthcare teams to ensure quality delivery of home health...
-
San Antonio, United States Optum Full timeRegistered Nurse RN Home Health San Antonio Texas at Optum summary: The Registered Nurse (RN) in Home Health at WellMed provides skilled nursing services and coordinates care for patients in their homes. This role involves assessing patient needs, developing care plans, and collaborating with healthcare teams to ensure quality delivery of home health...
-
San Antonio, TX, United States UnitedHealth Group Inc Full timeRegistered Nurse RN Quality Auditor WellMed Healthcare San Antonio TexasWellMed, part of the Optum family of businesses, is seeking a Registered Nurse RN Quality Auditor WellMed Healthcare to join our team in San Antonio, Texas. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care...
-
San Antonio, United States Optum Full timeRegistered Nurse RN Home Health San Antonio Texas at Optum summary: The Registered Nurse RN Home Health is responsible for providing skilled nursing services and coordinating home health care for patients in San Antonio, TX. This role involves assessing patient needs, developing personalized care plans, and ensuring compliance with health care regulations....
-
San Antonio, United States Optum Full timeRegistered Nurse RN Home Health San Antonio Texas at Optum summary: The Registered Nurse RN Home Health at WellMed in San Antonio plays a crucial role in delivering skilled nursing services and coordinating home health care for patients. The position involves assessing patients' needs, developing care plans, and implementing nursing interventions to ensure...
-
San Antonio, United States Optum Full timeRegistered Nurse RN Part-Time Home Health San Antonio Texas at Optum summary: The Registered Nurse (RN) part-time position at WellMed in San Antonio, Texas involves providing skilled nursing services in a home health care setting. The role includes developing and implementing patient care plans, coordinating care with healthcare teams, and ensuring...
-
San Antonio, United States Optum Full timeRegistered Nurse RN Home Health San Antonio Texas at Optum summary: A Registered Nurse (RN) specializing in home health care in San Antonio, Texas, providing skilled nursing services and assisting with care coordination for patients. The role involves performing assessments, developing care plans, administering medications and wound care, while ensuring...
-
San Antonio, Texas, United States UnitedHealth Group Inc Full timeRegistered Nurse RN Quality Auditor WellMed Healthcare San Antonio TexasWellMed, part of the Optum family of businesses, is seeking a Registered Nurse RN Quality Auditor WellMed Healthcare to join our team in San Antonio, Texas. Optum is a clinician-led care organization that is changing the way clinicians work and live.As a member of the Optum Care Delivery...
-
San Antonio, United States Optum Full timeRegistered Nurse RN Home Health San Antonio Texas at Optum summary: As a Registered Nurse in Home Health, you will deliver skilled nursing services and coordinate care for patients in the San Antonio area. You will perform comprehensive nursing assessments, manage care plans, and collaborate with the healthcare team to ensure high-quality patient outcomes....
-
San Antonio, United States Optum Full timeRegistered Nurse RN Home Health San Antonio Texas at Optum summary: The Registered Nurse RN in Home Health at WellMed, part of Optum, provides skilled nursing services and coordinates home health care for patients in San Antonio, TX. This role involves thorough nursing assessments, development of care plans, and collaboration with physicians and caregivers...
-
San Antonio, Texas, United States Optum Full timeRegistered Nurse RN Home Health San Antonio Texas at Optum summary:The Registered Nurse (RN) in Home Health at WellMed provides skilled nursing services and coordinates home health care for patients in San Antonio, TX. This role involves performing nursing assessments, developing care plans, and ensuring compliance with health care regulations. As part of a...
-
San Antonio, United States Optum Full timeRegistered Nurse RN Home Health San Antonio Texas at Optum summary: The Registered Nurse RN Home Health position at WellMed involves delivering skilled nursing services to patients in their homes, ensuring quality and compliance with healthcare regulations. The role includes conducting nursing assessments, coordinating care with the healthcare team,...
