MD or APC Sr. Clinical Practice Consultant - Remote

Optum; Eden Prairie (MN); Remote; USD 106,000 - 195,000; Full time

Job summary

Optum is seeking a Senior Clinical Practice Consultant to lead quality clinical documentation efforts. This remote position supports clinicians across the organization by ensuring documentation accuracy while mentoring team members and developing educational resources. Candidates should possess significant clinical experience, relevant certifications, and strong analytical skills to contribute to Optum's mission of providing quality healthcare.

Benefits

Comprehensive benefits package

Incentive and recognition programs

401k contribution

Qualifications

• Must have an active unrestricted state license.
• 5+ years of clinical practice experience required.
• Proven advanced knowledge in ICD-10-CM coding.

Responsibilities

• Lead clinical documentation review processes and ensure quality.
• Mentor team members and manage clinical review projects.
• Develop training materials and lead education sessions.

Skills

Analytical skills

Critical thinking

Interpersonal skills

Communication

Education

M.D. or D.O. with completed residency and board certification

Nurse Practitioner national certification

Certification by the National Commission on Certification of Physician Assistants

Coding certification from AAPC or AHIMA

Tools

EPIC

eClinical Works

Touchworks

Job description

MD or APC Sr. Clinical Practice Consultant - Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Senior Clinical Practice Performance physician (MD, DO), nurse practitioner (NP) or physician assistant (PA) will apply clinical expertise and knowledge of documentation guidelines to ensure quality of clinical documentation across Optum Health. This position will collaborate with a multidisciplinary team of clinicians, operations, and coding professionals as a member of the Clinical Documentation Review team within Optum Clinical Excellence. This position will provide support to Optum clinicians and leadership to promote excellence in clinical documentation.

This position is Monday - Friday and reports to the Director, Clinical Documentation Review, in Optum Clinical Excellence.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Serve as team subject matter expert on clinical documentation review processes and procedures
• Perform 1st, 2nd and 3rd level clinical chart reviews to ensure documentation accuracy by applying established clinical criteria for the diagnosing of medical conditions
• Collaborate with Clinical Performance Sr. Medical Director and Clinical Director to confirm accuracy of clinical review results
• Mentor new and existing team members and provide 1:1 coaching with team members
• Lead review projects end-to-end and manage team assignments
• Collaborate with business analysts to compile and analyze clinical review results
• Summarize clinical review results using presentation slides and feedback summary forms
• Present clinical review results to internal and external leaders
• Develop and implement new clinical review models and programs
• Create and/or update team clinical reference guides by adhering to national and Optum guidelines
• Collaborate with Optum national education team to ensure alignment of educational content
• Develop training materials for team orientation and ongoing education
• Lead and deliver team education sessions and group reviews
• Identify and implement measures for ongoing team education and competency testing for clinician review team
• Collaborate with Clinical Performance coding leaders to ensure alignment across clinical and coding review processes
• Assist with the design and implementation of clinical audit tools and platforms
• Performs related duties, as required

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:

• Active unrestricted state license to practice in respective clinical field
• Board certification in respective clinical field, for example:
  
  
  
  
  • M.D. or D.O. with completed residency and board certification
  • Nurse Practitioner national certification in Adult, Adult-Geriatric, Family or Acute
  • Certification by the National Commission on Certification of Physician Assistants (NCCPA)
  
  
  
  
• Coding certification from AAPC or AHIMA professional coding association, healthcare compliance certification, and/or additional coursework/experience in coding and/or Risk Adjustment
• 5+ years of clinical practice experience
• 3+ years of experience working with Medicare Advantage programs and CMS Risk Adjustment model
• 2+ years of experience in clinical documentation review or in a clinical quality program
• Proven solid clinical background in evidence-based medicine including chronic disease management and prevention
• Experience developing and delivering clinical education and training
• Proven advanced knowledge in ICD-10-CM coding and documentation requirements
• Ability to perform a comprehensive chart review of up to 50 medical records per day
• Technical experience using different clinical documentation systems (e.g., EPIC, eClinical Works, Touchworks, AI scribing solutions)
• Proficiency in MS applications (Excel, Outlook, Teams, PowerPoint & Word)
• Ability to be flexible and adapt to change based on departmental needs
• Proven excellent analytical and critical thinking skills
• Proven excellent verbal/written communication and interpersonal skills
• Ability to work independently and as part of a team in a fast-paced environment
• Ability to travel for on-site meetings two to three times per year

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

The salary range for this role is $106,800 to $194,200 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

UnitedHealth Group is 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 is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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