Registered Nurse RN Senior Clinical Coding Nurse Houston Texas

2 weeks ago

Humble, United States UnitedHealth Group Full time

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 RN 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

This is a Hybrid / Field Base position requiring travel in the Houston area.

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 Degree or Nursing Diploma from accredited nursing school with 2 or more years of additional experience may be substituted in lieu of a bachelor’s degree)

  • Current unrestricted Texas RN license or compact license

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

  • 5+ years of associated business experience with health care industry

  • 1+ years of ICD-9, ICD10 coding experience

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

  • 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

  • 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 highly desirable

  • MS Office Suite, moderate to advanced Excel and PowerPoint skills

  • 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

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.

  • Registered Nurse RN Senior Clinical Coding Nurse Houston Texas

    4 days ago

    Humble, TX, United States Optum Full time

    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...

  • Clinical Nurse Coordinator Emergency Room

    1 month ago

    Humble, United States HCA Houston Healthcare Kingwood Full time

    Description Introduction Do you want to be appreciated daily? Our nurses are celebrated for being on the front line, empathetic for patients. At HCA Houston Healthcare Kingwood our nurses set us apart from any other healthcare provider. We are seeking a Clinical Nurse Coordinator Emergency Room to join our healthcare family. Benefits HCA Houston Healthcare...

  • Registered Nurse PCU

    5 days ago

    Humble, United States HCA Houston Healthcare Kingwood Full time

    Description Introduction Do you currently have an opportunity to make a real impact with your work? With over 2,000 sites of care and serving over 31.2 million patient interactions every year, nurses at HCA Houston Healthcare Kingwood have the opportunity to make a real impact. As a(an) Registered Nurse PCU you can be a part of change. Benefits HCA Houston...

  • Registered Nurse Neuro ICU

    4 days ago

    Humble, United States HCA Houston Healthcare Kingwood Full time

    Description Introduction Do you currently have an opportunity to make a real impact with your work? With over 2,000 sites of care and serving over 31.2 million patient interactions every year, nurses at HCA Houston Healthcare Kingwood have the opportunity to make a real impact. As a(an) Registered Nurse Neuro ICU you can be a part of change. Benefits HCA...

  • Registered Nurse

    2 weeks ago

    Humble, United States Texas Children's Hospital Full time

    Registered Nurse (part-time) - TC Urgent Care Kingwood Job Summary We are searching for an Urgent Care Staff Nurse- someone who works well in a fast-paced setting. In this position, you will gather information, assess and provide direct care to patients. Works collaboratively with other member of the healthcare team to render age appropriate care. You are...

  • Registered Nurse

    4 weeks ago

    Humble, United States Harris Health System Full time

      Harris Health System is the public healthcare safety-net provider established in 1966 to serve the residents of Harris County, Texas. As an essential healthcare system, Harris Health champions better health for the entire community, with a focus on low-income uninsured and underinsured patients, through acute and primary care, wellness, disease management...

  • Registered Nurse

    3 weeks ago

    Humble, United States Harris Health System Full time

    Harris Health System is the public healthcare safety-net provider established in 1966 to serve the residents of Harris County, Texas. As an essential healthcare system, Harris Health champions better health for the entire community, with a focus on low-income uninsured and underinsured patients, through acute and primary care, wellness, disease management...

  • ER Registered Nurse, Nights, Northeast

    2 weeks ago

    Humble, United States Memorial Hermann Health System Full time

    At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed...

  • Registered Nurse Emergency Room Fsed Prn

    4 weeks ago

    Humble, United States KW FESER Atascocita Full time

    **Introduction**: Do you want to be appreciated daily? Our nurses are celebrated for being on the front line, empathetic for patients. At HCA Houston Kingwood - Atascocita FSED our nurses set us apart from any other healthcare provider. We are seeking a Registered Nurse Emergency Room PRN to join our healthcare family. **Benefits**: HCA Houston Kingwood -...

  • Registered Nurse

    2 weeks ago

    Humble, United States FCM Group, LLC dba Nurse Next Door - Pearland & Kingwood Full time

    Benefits/PerksFlexible SchedulingCompetitive CompensationCareers Advancement Job SummaryWe are seeking a Registered Nurse to join our team. In this role, you will primarily be creating and managing a plan of care for individual patients. You are a Registered Nurse (RN) who operates with great attention to detail and a big heart. You take pride in creating...

  • Registered Nurse

    3 months ago

    Humble, United States FCM Group, LLC dba Nurse Next Door - Pearland & Kingwood Full time

    Benefits/PerksFlexible SchedulingCompetitive CompensationCareers Advancement Job SummaryWe are seeking a Registered Nurse to join our team. In this role, you will primarily be creating and managing a plan of care for individual patients. You are a Registered Nurse (RN) who operates with great attention to detail and a big heart. You take pride in creating...

  • Registered Nurse

    1 month ago

    Humble, United States FCM Group, LLC dba Nurse Next Door - Pearland & Kingwood Full time

    Job DescriptionJob DescriptionBenefits/PerksFlexible SchedulingCompetitive CompensationCareers AdvancementJob SummaryWe are seeking a Registered Nurse to join our team. In this role, you will primarily be creating and managing a plan of care for individual patients. You are a Registered Nurse (RN) who operates with great attention to detail and a big heart....

  • Registered Nurse

    1 month ago

    Humble, United States FCM Group, LLC dba Nurse Next Door - Pearland & Kingwood Full time

    Job DescriptionJob DescriptionBenefits/PerksFlexible SchedulingCompetitive CompensationCareers AdvancementJob SummaryWe are seeking a Registered Nurse to join our team. In this role, you will primarily be creating and managing a plan of care for individual patients. You are a Registered Nurse (RN) who operates with great attention to detail and a big heart....

  • Charge Nurse RN

    3 weeks ago

    Humble, United States Fundamental Administrative Services, LLC Full time

    Charge Nurse RNCome Join Our Nursing Team! Morning Shift (12hrs.) POSITION SUMMARY: Working as a Charge Nurse in long term care is an opportunity unique from all other health care facilities. Not only are supervisory and leadership experience essential, but Charge Nurses in long term care must also possess compassion, patience, and understanding to truly...

  • Registered Nurse Emergency Room FSED

    1 week ago

    Humble, United States KW FESER Atascocita Full time

    Description IntroductionAre you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as a(an) Emergency Room RN today with HCA Houston Healthcare Kingwood - Atascocita FSED.BenefitsHCA Houston Healthcare Kingwood - Atascocita FSED offers a...

  • Registered Nurse Emergency Room FSED

    2 weeks ago

    Humble, United States KW FESER Atascocita Full time

    Description IntroductionAre you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as a(an) Emergency Room RN today with HCA Houston Healthcare Kingwood - Atascocita FSED.BenefitsHCA Houston Healthcare Kingwood - Atascocita FSED offers a...

  • Registered Nurse Emergency Room FSED PRN

    4 weeks ago

    Humble, United States KW FESER Atascocita Full time

    Description IntroductionDo you want to be appreciated daily? Our nurses are celebrated for being on the front line, empathetic for patients. At HCA Houston Kingwood - Atascocita FSED our nurses set us apart from any other healthcare provider. We are seeking a Registered Nurse Emergency Room PRN to join our healthcare family.BenefitsHCA Houston Kingwood -...

  • Rad Tech Travel Contract

    3 weeks ago

    Humble, United States Sunbelt Staffing Full time

    Job DescriptionJob DescriptionMinimum 1+ years imaging experience required.Are you an experienced X-Ray Technologist looking for a new opportunity in the vibrant Houston area? Join our dynamic healthcare team and enjoy 12-hour shifts that allow for a great work-life balance! Position: X-Ray Technologist Location: Near Houston, TX Shift: 12-hour shifts, 7am...

  • Registered Nurse

    3 months ago

    Humble, United States FCM Group, LLC dba Nurse Next Door - Pearland & Kingwood Full time

    **Benefits/Perks** - Flexible Scheduling - Competitive Compensation - Careers Advancement **Job Summary** We are seeking a Registered Nurse to join our team. In this role, you will primarily be creating and managing a plan of care for individual patients. You are a Registered Nurse (RN) who operates with great attention to detail and a big heart. You take...

  • Charge Nurse RN

    2 weeks ago

    Humble, United States Crimson Heights Health and Wellness Full time

    Come Join Our Nursing Team! Morning Shift (12hrs.) POSITION SUMMARY: Working as a Charge Nurse in long term care is an opportunity unique from all other health care facilities. Not only are supervisory and leadership experience essential, but Charge Nurses in long term care must also possess compassion, patience, and understanding to truly be successful. If...