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UnitedHealth Group Nurse - Clinical Educator - Farmington, CT in Farmington, Connecticut

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 is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

The Nurse Quality/Clinical Educator (Risk Adjustment) will be responsible for the day to day management of Quality programs, initiatives, and reporting as well as for Risk Adjustment activities for OptumCare CT IPA providers. The existing quality programs at OptumCare CT IPA are recognized as the best in the state by many business partners. In the Quality role, you would provide support to the teams implementing and reporting on these programs. The main risk initiatives for the Clinical Educator will be provider education, chart review, and ensuring accurate coding and documentation across the organization. OptumCare CT IPA is a dynamic group of physician-led medical groups across CT and is part of the larger OptumCare national entity. The position requires working with both local and national leaders. The IPA is a multi-payor contracting vehicle that currently holds Medicare Advantage risk contracts as well as shared savings contracts. Our goal is to provide the highest quality of care at an affordable cost for our members.

ProHealth Central Office in Farmington, a part of Optum has an immediate opening for a friendly, patient focused and detailed oriented Nurse-Clinical Educator to join our team. This position will require travel throughout the CT area. This is a full-time Monday-Friday position with hours between 7:00am-5:00pm. Exact schedule to be determined and flexibility is required.

Primary Responsibilities:

  • Work collaboratively with Clinical and technical resources to ensure quality programs are effective and reporting is completed to meet deadlines requirements

  • Weekly touch points with IPA practice site resources to support Risk and Quality programs and reporting

  • Collaborate with Senior Quality Liaison to identify and support 5 STAR quality targets for OptumCare CT IPA

  • Manage and Monitor IPA programs participation and outcomes

  • Monitor Quality and Risk platforms regularly to assist IPA practices in prioritizing outreach efforts

  • Monitor and ensure that all users on the Quality platform are properly trained to complete supplemental data submissions - provide additional support/education on rejections as needed

  • Act as a Subject Matter Expert on Quality platforms and supplemental data submissions

  • Plan, conduct and coordinate all aspects of MRA (Medicare Risk Adjustment) process evaluation and education to internal and external partners

  • Communicating a comprehensive understanding of Medicare Risk Adjustment, Documentation & Coding guidelines to both external/internal partners while ensuring compliance with regulatory

  • Analyze reports to identify and report documentation/coding trends to create opportunities for improvement with internal and external partners

  • Ensure provider documentation and diagnostic code selections are appropriate and recommend improvements as necessary, including system-view recommendations based on EMR scope

  • Continually assess the knowledge and appropriate application of ICD-10 documentation and coding guidelines

  • Leverage reporting benchmarks and MRA success measures to prioritize efforts

  • Demonstrate a professional and effective face to face communication style and address issues as they arise

  • Act promptly in routine situations while building productive relationships and establish rapport

  • Act as a Subject matter expert on Risk platforms

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:

  • Current, unrestricted RN license for the state of Connecticut

  • 3+ years of clinical practice experience, working in a provider setting

  • Experience with Microsoft applications such as Word, Outlook, Excel and PowerPoint

  • Ability to travel within Connecticut offices to conduct on-site education sessions

Preferred Qualifications:

  • BSN or MSN

  • CPC or CRC certification

  • 5+ years of clinical practice experience, working in a provider setting

  • 2+ years of experience working with Medicare Risk Adjustment (MRA)

  • Billing and coding OR medical office management experience

  • Familiarity with outpatient / inpatient billing processes

  • Solid understanding of coding principles preferred

  • Excellent facilitation, consulting, and delivery of complex content

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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)

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

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: RN, Nurse Educator, HCC Coding, ProHealth, Nurse Coder, Coding Documentation, Healthcare, CT, Connecticut, Farmington, Primary Care, CDQI, Hartford, CT, Waterbury, Connecticut Risk Adjustment, CPC, CRC