Clinical Documentation Integrity Specialist RN

NaviHealth; Worcester (MA); Remote; USD 40,000 - 72,000; Full time

Benefits offered by this job

Benefits package

Equity stock purchase & 401k

Job summary

Reliant Medical Group, part of the Optum family, is seeking a Registered Nurse to support risk adjustment programs in a remote-capable role. You will review clinical documentation, support HCC coding, and collaborate with the coding education team to ensure accurate problem lists and compliant coding.

The ideal candidate is licensed in Massachusetts, has strong nursing experience in chronic disease care, and is proficient with EMR systems.

Qualifications

• Graduate of a state-approved school of nursing.
• Current, unrestricted license to practice professional nursing in Massachusetts.
• Experience or certification in risk adjustment coding (CPC/CCS/CCS-H/CRC) or ability to obtain.

Responsibilities

• Review encounters in the EMR to ensure accuracy of clinician documentation for risk adjustment standards.
• Substantiate HCC diagnoses that are billed or relevant but not on the patient’s problem list.
• Provide concurrent and retrospective abstraction for Reliant Risk Adjustment programs.
• Conduct chart reviews for supporting documentation of diagnoses and update the Problem List accordingly.
• Update patient problem lists and diagnoses in the EMR for risk adjustment purposes.
• Collaborate with coding education team to train clinicians on risk adjustment programs.

Skills

Nursing

Critical thinking

Communication

Detail oriented

Education

State-approved nursing program

Tools

EMR systems

Job description

Opportunities with Reliant Medical Group, part of the Optum family of businesses. Join a community-based, multi-specialty, physician-led organization where you will work with talented peers on a common purpose: improving the quality, cost and experience of health care. Here, we focus on delivering the best patient care, rather than volume. Through innovation and superior care management, we support patients and your well-being as a team member. Join a team at the forefront of value-based care and discover the meaning behind Caring. Connecting. Growing together.

As the Registered Nurse, you will be responsible for effective care delivery and management of patient care within a specialty, utilizing the nursing process and adhering to current standards of nursing practice. Communicates and coordinates effectively with all entities involved in the care of the patient to promote safe, high quality care. Making decisions reflecting critical thinking and evidence based nursing practice.

Position Details:

• Location: Remote (MA Residents only)
• Department: Population Health- Risk adjustment
• Schedule: Full time, 40HRS Weekly

If you are a MA resident, you will have the flexibility to work remotely* as you take on some tough challenges

Primary Responsibilities:

• Reviews encounters in the electronic medical record to ensure accuracy and appropriateness of clinician documentation using relevant risk adjustment program standards
• Utilizes abstract reports to substantiate HCC diagnoses that have been billed and/or are considered relevant but do not appear on the patient's problem list
• Provides concurrent and retrospective abstraction for all Reliant Risk Adjustment programs
• Independently conducts chart reviews for supporting documentation of diagnosis codes which can be added to Problem List. Assigns accurate diagnosis codes to Problem List; follows standard work for adding diagnoses to Problem List
• Reviews new Reliant Medical Group patients for potential diagnoses supporting risk adjustment programs and updates problem list in the electronic medical record
• With coding education team, provides clinician training for risk adjustment programs. Ad hoc visits to clinical sites may be scheduled to enhance coordination of team-based care and to facilitate clinician education
• Participates in development, implementation, and monitoring of procedures that support organizational goals and business objective related to risk adjustment capture
• Utilizes thorough understanding of CMS/Medicare coding regulations as well as technical knowledge of ICD-10 and CPT systems
• Performs other duties as assigned

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:

• Graduate of a State-approved school of nursing
• Current, unrestricted, license to practice professional nursing in the Commonwealth of Massachusetts
• Certification as professional coder (CPC, CCS-P, CCS, CPC-H, CRC-risk, AAPC) or ability to obtain certification while working in the position
• American Heart Association Basic Life Support (BLS)

• 3+ years nursing experience with at least 3 years of clinical experience with chronic disease patient populations in an ambulatory or inpatient setting

Preferred Qualifications:

• Bachelor of Science in Nursing (BSN)
• Advanced Cardiac Life Support (ACLS) may be required based on specialty
• 2+ years of RN experience in a variety of specialties and multiple diseases within each specialty
• Computer experience with the ability to use word processing and spreadsheet programs
• Electronic medical record (EMR) experience and/or aptitude to master the EMR based on other technology experience
• Proven solid written communication skills
• Proven solid critical thinking, problem solving, interpersonal and patient interviewing skills
• Proven ability to interpret clinical information, assess the implication of treatment and develop and implement a plan of care
• Proven ability to prioritize, multitask, and work in a rapidly changing environment with multiple demands
• Proven excellence in practice, documentation, and cost-effective care utilization. Maintains high patient satisfaction

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29 - $52 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment. yment