RN Clinical Documentation & Risk-Adjustment Specialist

UnitedHealth Group; Massachusetts; On-site; USD 40,000 - 72,000; Full time

Job summary

UnitedHealth Group is seeking a Clinical Documentation Integrity Specialist RN in Worcester, MA. The role focuses on accurate clinician documentation and risk adjustment through concurrent and retrospective abstraction within Reliant programs.

Required is a state-approved nursing education and 3+ years of chronic-disease nursing experience, with BLS certification and CPC/CCS-type credentials preferred. Full-time, on-site in Worcester, 40 hours weekly.

Qualifications

• 3+ years of nursing experience with chronic disease patient populations.
• Experience in ambulatory or inpatient settings.
• Familiarity with CMS/Medicare coding concepts and documentation practices.

Responsibilities

• Review encounters in the EMR to ensure accuracy of clinician documentation.
• Substantiate HCC diagnoses using abstract reports.
• Provide concurrent and retrospective abstraction for Reliant Risk Adjustment programs.
• Perform chart reviews for supporting documentation of diagnoses for the Problem List.
• Review new Reliant Medical Group patients for potential diagnoses supporting risk adjustment programs.
• Provide clinician training for risk adjustment programs with the coding education team.
• Develop and monitor procedures that support risk adjustment capture and organizational goals.
• Apply knowledge of ICD-10 and CPT coding regulations.

Skills

Clinical documentation

Risk adjustment knowledge

Education

State-approved nursing program

Job description

UnitedHealth Group is seeking a Clinical Documentation Integrity Specialist RN in Worcester, MA. The role focuses on accurate clinician documentation and risk adjustment through concurrent and retrospective abstraction within Reliant programs.

Required is a state-approved nursing education and 3+ years of chronic-disease nursing experience, with BLS certification and CPC/CCS-type credentials preferred. Full-time, on-site in Worcester, 40 hours weekly.