Senior RA & Clinical Coding Nurse Consultant

UnitedHealth Group; Irving (TX); On-site; Confidential; Full time

Benefits offered by this job

Comprehensive benefits

Incentive programs

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group, including WellMed, seeks a Senior Clinical Coding Nurse Consultant (Sr. CCNC) to lead Risk Adjustment practices. You will guide DataRAP operations, educate regions on HCC guidelines, and collaborate with clinicians to enhance RA reporting and care quality.

This role emphasizes compliance, data-driven decision making, and cross-team coordination. The ideal candidate is a licensed RN with CPC certification, strong CMS/HCC knowledge, and the ability to travel locally and beyond.

Qualifications

• RN license (current, unrestricted)
• Bachelor's degree or substitution with 4+ years RN nursing experience
• CPC certification within 9 months of hire
• Understanding of CMS HCC Model, Medicare Advantage, and ICD-10-CM guidelines
• Strong communication, time management, and independent work skills
• Proficiency with MS Office 365 (Excel, PowerPoint, OneNote)
• Willingness to travel locally and non-locally (DFW area preferred)

Responsibilities

• Act as subject matter expert for RA activities in assigned market(s) and matrix environment
• Collaborate with clinicians and leadership on RA reporting to improve member care
• Provide analytical interpretation of RA reporting
• Educate/train on RA metrics with central/regional teams
• Participate in RA Chart Retrieval Project to collect provider charts
• Attend regularly scheduled Business Review meetings on RA activities
• Evaluate provider group operations to optimize RA workflows
• Develop user-friendly RA solutions with regional and central leaders
• Assist DataRAP senior leadership on special projects
• Perform other RA duties as assigned

Skills

CMS HCC Model

Medicare Advantage

ICD-10-CM guidelines

Critical thinking

Time management

Independent work

Verbal/written communication

MS Office 365

Travel

Live in DFW area

Driver's License

Education

Bachelor of Science in Nursing

Associate degree in nursing with substitution

Tools

CPC Certification

Job description

UnitedHealth Group, including WellMed, seeks a Senior Clinical Coding Nurse Consultant (Sr. CCNC) to lead Risk Adjustment practices. You will guide DataRAP operations, educate regions on HCC guidelines, and collaborate with clinicians to enhance RA reporting and care quality.

This role emphasizes compliance, data-driven decision making, and cross-team coordination. The ideal candidate is a licensed RN with CPC certification, strong CMS/HCC knowledge, and the ability to travel locally and beyond.