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Licensed Risk Assessment Nurse (RN/LPN) - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Parsippany, New Jersey |
About this job
The Licensed Risk Assessment Nurse position is a new and exciting role within the New Jersey market. You will be required to travel 50-75% within the state of New Jersey.
POSITION SUMMARY
As the Licensed Risk Assessment Nurse (RN or LPN), you will facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. You will develop, implement, and support Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.
Nurses that currently have the CPC certification will be expected to obtain the CRC certification within 6 months post hire. Nurses that are currently not a certified coder will have to obtain the CRC coding certification within 6 months post hire.
Fundamental Components:
- Works on-site in physician offices to assist with scheduling appointments for health risk asessments and other related medical services in support of our commercial exchange members who may have a gap in care.
- Educate providers on how to properly document medical services and interventions received during face to face member encounters. This documentation includes proper coding and claim submission for services rendered.
- Perform audits of medical records to ensure all assigned ICD-9 codes are accurate and supported by written clinical documentation.
- Serve as the training resource and subject matter expert to regionally aligned network practices identifies and recommends opportunities for process improvements at the practice level to improve overall risk adjustment scores and gaps
- Share best practices in risk adjustment across all sites/regions.
- Participate in workgroups to develop learning strategies to improve healthcare delivery performance and simultaneously manage multiple, complex projects.
BACKGROUND/EXPERIENCE
- Knowledge of regulatory/accreditory guidelines
- Knowledge of quality of care and member safety issues
- Min 4yrs. recent and relevant experience in medical record documentation review, diagnosis coding and/or auditing
CPC or CCS-P
- Experience with ICD-9, ICD-10, and CPT
- Experience with Medicare/Commercial risk adjustment process
- Experience of electronic medical records
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
An active and good standing Registered Nurse (RN) license OR a Licensed Practical Nurse (LPN) is required.
FUNCTIONAL EXPERIENCES
Functional - Clinical / Medical/Clinical claim review & coding/4-6 Years
Functional - Claims/Policies & procedures/4-6 Years
Functional - Medical Management/Medical Management - Coding/4-6 Years
Functional - Products-Medical/All Aetna Standard Plans/4-6 Years
TECHNOLOGY EXPERIENCES
Technical - Aetna Applications/Aecclaims East/1-3 Years/Administrator
ADDITIONAL SKILLS
- Benefits Management/Interacting with Medical Professionals/FOUNDATION
- Finance/Managing Aetnas Risk/FOUNDATION
- General Business/Communicating for Impact/FOUNDATION
- Leadership/Collaborating for Results/FOUNDATION
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Employment Type Regular Career Band Description Professional
POSITION SUMMARY
As the Licensed Risk Assessment Nurse (RN or LPN), you will facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. You will develop, implement, and support Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.
Nurses that currently have the CPC certification will be expected to obtain the CRC certification within 6 months post hire. Nurses that are currently not a certified coder will have to obtain the CRC coding certification within 6 months post hire.
Fundamental Components:
- Works on-site in physician offices to assist with scheduling appointments for health risk asessments and other related medical services in support of our commercial exchange members who may have a gap in care.
- Educate providers on how to properly document medical services and interventions received during face to face member encounters. This documentation includes proper coding and claim submission for services rendered.
- Perform audits of medical records to ensure all assigned ICD-9 codes are accurate and supported by written clinical documentation.
- Serve as the training resource and subject matter expert to regionally aligned network practices identifies and recommends opportunities for process improvements at the practice level to improve overall risk adjustment scores and gaps
- Share best practices in risk adjustment across all sites/regions.
- Participate in workgroups to develop learning strategies to improve healthcare delivery performance and simultaneously manage multiple, complex projects.
BACKGROUND/EXPERIENCE
- Knowledge of regulatory/accreditory guidelines
- Knowledge of quality of care and member safety issues
- Min 4yrs. recent and relevant experience in medical record documentation review, diagnosis coding and/or auditing
CPC or CCS-P
- Experience with ICD-9, ICD-10, and CPT
- Experience with Medicare/Commercial risk adjustment process
- Experience of electronic medical records
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
An active and good standing Registered Nurse (RN) license OR a Licensed Practical Nurse (LPN) is required.
FUNCTIONAL EXPERIENCES
Functional - Clinical / Medical/Clinical claim review & coding/4-6 Years
Functional - Claims/Policies & procedures/4-6 Years
Functional - Medical Management/Medical Management - Coding/4-6 Years
Functional - Products-Medical/All Aetna Standard Plans/4-6 Years
TECHNOLOGY EXPERIENCES
Technical - Aetna Applications/Aecclaims East/1-3 Years/Administrator
ADDITIONAL SKILLS
- Benefits Management/Interacting with Medical Professionals/FOUNDATION
- Finance/Managing Aetnas Risk/FOUNDATION
- General Business/Communicating for Impact/FOUNDATION
- Leadership/Collaborating for Results/FOUNDATION
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Employment Type Regular Career Band Description Professional