Remote RN: Clinical Documentation & Risk Adjustment

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

Benefits offered by this job

Remote work eligible (MA residents)

Competitive benefits

Job summary

Reliant Medical Group, part of the Optum family, seeks a Registered Nurse for remote work (MA residents). You will review clinical documentation, abstract risk adjustment data, and support coding education while ensuring high-quality patient care and adherence to CMS regulations.

The role requires MA RN licensure, BLS, and 3+ years in chronic disease care; CPC/CCS-P certification or ability to obtain is preferred. Remote work policy applies to eligible MA residents.

Qualifications

• Graduate of a State-approved school of nursing.
• Current, unrestricted MA nursing license.
• Certification as professional coder (CPC, CCS-P, CCS, CPC-H, CRC) or ability to obtain certification.
• American Heart Association Basic Life Support (BLS).
• 3+ years nursing experience with chronic disease populations in ambulatory or inpatient settings.

Responsibilities

• Reviews encounters in the EMR to ensure accuracy and appropriateness of clinician documentation.
• Substantiates HCC diagnoses using risk adjustment program standards.
• Provides concurrent and retrospective abstraction for Reliant Risk Adjustment programs.
• Charts reviews to support diagnosis codes added to the Problem List.
• Updates patient problem list and supporting diagnoses in the EMR.
• Assists in clinician education and risk adjustment process improvements.

Skills

CPC/CCS-P certification

BLS

Communication skills

CMS/Medicare coding knowledge

Ambulatory care experience

Education

Nursing degree

Massachusetts RN license

Tools

EMR software

Job description

Reliant Medical Group, part of the Optum family, seeks a Registered Nurse for remote work (MA residents). You will review clinical documentation, abstract risk adjustment data, and support coding education while ensuring high-quality patient care and adherence to CMS regulations.

The role requires MA RN licensure, BLS, and 3+ years in chronic disease care; CPC/CCS-P certification or ability to obtain is preferred. Remote work policy applies to eligible MA residents.