Senior Clinical Coding Nurse Consultant

2 months ago

Cedar Park, United States UnitedHealth Group Full time

$. Sign on Bonus Available for External Candidates

Incentive Bonus Annually

23 days of PTO & Closed on Major Holidays

 K Match

 This position is located in Austin, Texas and is NOT a Remote position

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start 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 metricsProvide analytical interpretation of Risk Adjustment reporting including, Executive Summaries, HCC Ratio, Disagree and Resolution rates, and FaxBack reporting to plan and provider groupsSubject 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 operationsAssist in developing of training and analytical materials for Risk AdjustmentOversee 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 AdjustmentAnalyze 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 successOversee market specific chart retrieval and review of PCP, Hospital, and Specialist recordsWork 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 standingCPC certification or proof that certification has been obtained within 9 months from the American Academy of Professional Coders 5+ years associated business experience with health care industry1+ years of ICD-9, ICD10 coding experienceKnowledge of CMS HCC Model and Guidelines along with ICD 10 GuidelinesProfessional experience persuading changes in behaviorSolid knowledge of the Medicare market, products and competitorsKnowledge base of clinical standards of care and preventative health measuresAbility and willingness to travel (locally and non-locally) as determined by business needs.

Preferred Qualifications:

Undergraduate degreeMedical/clinical backgroundExperience in managed care working with network and provider relationsSolid presentation skills and relationship building skills with clinical/non-clinical personnelMS Office Suite, moderate to advanced EXCEL and PowerPoint skillsAdditional Medical chart review experienceDemonstrated ability to interact with medical staff, peers, and internal company staff at all levelsAbility to solve process problems crossing multiple functional areas and business unitsSolid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of actionGood business acumen, especially as it relates to Medicare

Physical & Mental Requirements: 

Ability to lift up to 10 poundsAbility to sit for extended periods of timeAbility to stand for extended periods of timeAbility to use fine motor skills to operate equipment and/or machineryAbility to receive and comprehend instructions verbally and/or in writingAbility to use logical reasoning for simple and complex problem solving

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: 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.

  • Senior Clinical Coordinator RN

    1 month ago

    Overland Park, Kansas, United States Brookdale Senior Living Full time

    Job SummaryBrookdale Senior Living is seeking a highly skilled and experienced Senior Clinical Coordinator RN to join our team. As a key member of our clinical services team, you will be responsible for conducting and coordinating the development and completion of resident assessments, ensuring compliance with state and federal regulations.Key...

  • Senior Care Nurse

    4 weeks ago

    Tinley Park, Illinois, United States Bickford Senior Living Full time

    Senior Care Nurse OpportunityAt Bickford Senior Living, we are dedicated to providing high-quality care to our residents. As a Senior Care Nurse, you will play a vital role in ensuring that our residents receive the best possible care. Responsibilities:Support resident care within the branch, ensuring that residents' daily medication needs are met in a...

  • Senior Finance Consultant

    1 month ago

    Winter Park, Florida, United States RVR Consulting Group Full time

    Job Title: Senior Finance ConsultantRVR Consulting Group is seeking a highly skilled Senior Finance Consultant to join our team. As a key member of our consulting team, you will be responsible for developing financial models, performing financial and data analysis, and supporting M&A activities.Key Responsibilities:Develop financial models that provide...

  • Clinical Dietician

    4 weeks ago

    Overland Park, Kansas, United States Brookdale Senior Living Full time

    Job SummaryBrookdale Senior Living is seeking a highly skilled Clinical Dietician to join our team. As a Clinical Dietician, you will play a vital role in ensuring the nutritional well-being of our residents.Key ResponsibilitiesConduct nutritional assessments and develop personalized care plans for residentsConsult with residents to evaluate their...

  • Certified Nursing Assistant

    4 weeks ago

    Overland Park, Kansas, United States Sunrise Senior Living Full time

    Sunrise Senior Living is dedicated to providing high-quality care for seniors, and we're seeking a skilled Certified Nursing Assistant to join our team.Responsibilities:Provide direct resident care, including nursing/clinical care, personal, nutritional, and restorative care.Partner with licensed nursing staff to plan, develop, and execute individualized...

  • Psychiatric Mental Health Nurse Practitioner

    4 weeks ago

    Cedar Park, Texas, United States Discovery Behavioral Health Full time

    Psychiatric Mental Health Nurse Practitioner - Clinical SpecialistJob SummaryWe are seeking a highly skilled Psychiatric Mental Health Nurse Practitioner to join our team at Discovery Behavioral Health. As a Clinical Specialist, you will provide direct clinical services for a variety of psychiatric conditions in an outpatient setting.Key Responsibilities...

  • Senior Retail Sales Associate

    1 month ago

    Cedar Park, Texas, United States Spohn & Associates Full time

    Job Details Job Title: Senior Retail Sales Associate Job Summary: We are seeking a highly motivated and experienced Senior Retail Sales Associate to join our team at Collectors Crossroads in North Austin. As a Senior Retail Sales Associate, you will be responsible for providing exceptional customer service, building strong relationships with clients, and...

  • Nurse Manager

    4 weeks ago

    Waite Park, Minnesota, United States Sterling Park Senior Living Full time

    Sterling Park Senior Living is seeking a dedicated Nurse Manager to join our clinical team. In this role, you will support the Director of Nursing and MDS Nurse in providing exceptional care to our residents. As a Registered Nurse with a background in long-term care, you will be responsible for planning, organizing, and directing the overall operations of...

  • Clinical Nutrition Specialist

    4 weeks ago

    Overland Park, Kansas, United States Brookdale Senior Living Full time

    OverviewBrookdale Senior Living is a leading provider of senior living communities, dedicated to enhancing the lives of our residents. As a Clinical Nutrition Specialist, you will play a vital role in ensuring the nutritional well-being of our residents, working collaboratively with our exceptional team to provide exceptional care.ResponsibilitiesDevelop and...

  • Senior MS SharePoint Consultant and Developer

    2 weeks ago

    Ridgefield Park, United States BTI Solutions Full time

    Why work with us?Proven people. Everyone on our team has earned a CPC (Certified Personnel Consultant) or CTS (Certified Temporary Staffing Specialist) accreditation from the National Association of Personnel Services. We are experts at staffing and recruiting with more than 16 years of experience serving employers. Proven process. Our approach to staffing...

  • Senior Clinical Nurse, Medical Cardiology

    1 month ago

    Averill Park, United States Albany Medical Center Full time

    Senior Clinical Nurse, Medical Cardiology The Senior Clinical Nurse in the Medical Cardiology unit is responsible for assessing, coordinating, planning, and managing the needs of patients throughout their care. This includes focusing on progress toward discharge and ensuring the delivery of competent, compassionate patient care. The unit serves a diverse...

  • Senior Care Coordinator

    4 weeks ago

    Cedar Hill, Texas, United States Your Tailor Made Senior Service Full time

    About Us:Your Tailor Made Senior Service Home Health is a leading provider of personalized senior care services. We are dedicated to enhancing the quality of life for seniors by delivering compassionate and tailored home healthcare solutions. Our team is committed to providing the highest level of care and support to our senior clients, helping them maintain...

  • Clinical Dietician

    4 weeks ago

    Overland Park, Kansas, United States Brookdale Senior Living Full time

    Nutrition Expertise for a Better LifeAt Brookdale Senior Living, we're committed to providing exceptional care and services to our residents. As a Clinical Dietician, you'll play a vital role in ensuring our residents receive the best possible nutritional care.Responsibilities:Conduct nutritional assessments and develop personalized care plans for...

  • Senior Care Coordinator

    1 month ago

    Cedar Hill, Texas, United States Your Tailor Made Senior Service Full time

    About UsYour Tailor Made Senior Service is a leading provider of personalized senior care services. We are dedicated to enhancing the quality of life for seniors by delivering compassionate and tailored home healthcare solutions. Our team is committed to providing the highest level of care and support to our senior clients, helping them maintain their...

  • Senior Business Risk Consultant

    3 weeks ago

    Park Ridge, United States The LaSalle Group Full time

    LaSalle Network has partnered with a leading consulting firm looking to hire on a new Senior Business Risk Consultant to join their team in developing and implementing comprehensive risk management strategies for Fortune 500 clients. The ideal candidate will bring deep expertise in enterprise risk management, regulatory compliance and business continuity...

  • Licensed Practical Nurse

    4 weeks ago

    Overland Park, Kansas, United States Erickson Senior Living Full time

    At Erickson Senior Living, we are seeking a skilled Licensed Practical Nurse (LPN) to join our team at Tallgrass Creek. As a LPN, you will play a vital role in providing clinical care to our residents, working closely with our interdisciplinary team to ensure the highest level of care and service.Key Responsibilities:Assess and evaluate resident clinical...

  • Senior Care Nurse

    4 weeks ago

    Clifton Park, New York, United States Peregrine Senior Living Full time

    Job Summary:We are seeking a compassionate and dedicated Licensed Practical Nurse (LPN) to join our team at Peregrine Senior Living. As a LPN, you will play a vital role in providing exceptional care and supervision to our senior residents.Responsibilities: Ensure compliance with all regulations regarding residents' rights. Assist residents with activities...

  • Senior Systems Engineer Consultant

    4 weeks ago

    Cedar Rapids, Iowa, United States RTX Full time

    RTX is seeking a highly skilled Senior Systems Engineer Consultant to join our Avionics team. As a key member of our team, you will be responsible for advancing flight deck solutions, airborne communications, vision systems, sensors, and fire protection for commercial and military customers around the world.The ideal candidate will have a strong background...

  • Psychiatric Mental Health Nurse Practitioner

    4 weeks ago

    Cedar Park, Texas, United States Anew Era TMS Full time

    Job SummaryThe Psychiatric Mental Health Nurse Practitioner will provide direct clinical services for a variety of psychiatric conditions in an outpatient setting. This role requires a strong understanding of TMS treatment protocols and the ability to engage patients in therapy.Key ResponsibilitiesEvaluate scheduled patients consistent with prevailing...

  • Senior Clinical Trial Manager Consultant

    2 months ago

    Menlo Park, United States ReCode Therapeutics Full time

    Who We Are: ReCode Therapeutics is a clinical-stage genetic medicines company using precision delivery to power the next wave of mRNA and gene correction therapeutics. ReCode’s proprietary Selective Organ Targeting (SORT) lipid nanoparticle (LNP) platform enables highly precise and targeted delivery of genetic medicines directly to the organs, tissues and...