Healthcare Professional Lead

6 days ago


Gonzales, Texas, United States UnitedHealth Group Full time
Job Summary:
The UnitedHealth Group is seeking a highly skilled RN Clinical Coding Nurse Consultant to join our team in San Antonio, Texas. As a key member of our Optum Care Delivery team, you will play a vital role in shaping the future of healthcare by driving consistent, efficient processes and sharing best practices with Providers and Market Teams.

About the Role:
This Sr. Clinical Coding Nurse Consultant position is responsible for developing and implementing market business plans to motivate providers to engage in improving Risk Adjustment metrics. You will provide analytical interpretation of Risk Adjustment reporting, including Executive Summaries, HCC Ratio, Disagree and Resolution rates, and FaxBack reporting to plan and provider groups. Your expertise as a Subject Matter Expert (SME) for all Risk Adjustment related activities within your assigned market(s) working within a matrix relationship which includes DataRAP operations and Regional/Market operations is crucial to success in this role.

Main 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
* Serve as Subject Matter Expert (SME) for all Risk Adjustment related activities within your assigned market(s)
* Assist in developing 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

Requirements:
* 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 the healthcare industry
* 1+ years of familiarization with ICD10 codes

Benefits:
As a valued member of our team, you can expect a competitive salary range of $85,000 - $115,000 per year, based on qualifications and location, along with a comprehensive benefits package, including medical, dental, and vision coverage, 401(k) retirement plan, and paid time off.

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