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Nurse Health Risk Educator - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Salt Lake City, UT Salt Lake City, Utah |
About this job
POSITION SUMMARY
Works with internal business partner (specifically the CRMO clinical coding team), to develop relationships with local networks and health care management teams to educate, train, and provide face to face support to physician practice groups who serve our commercial exchange membership (both on and off exchanges, individual and small group clients) in support of risk adjustment.
Local travel between 50% to 60%
Telework within the Nevada and Utah area
Fundamental Components:
Uses clinical skills to assess, plan, monitor and evaluate healthcare services in the provider office setting participating in direct patient care and assessment. - Responsible for educating providers on how to properly document medical services and interventions received during face to face encounters, including proper coding and claim submission for services rendered. - Works on-site in physician offices to assist with scheduling appointments for health risk assessments and other related medical services in support of our commercial exchange members who may have a gap in care. - Serves as a liaison to peers to provide in-depth clinical knowledge and expertise to support the education of providers. - Performs audits of medical records to ensure all assigned ICD-9/10 codes are accurate and supported by written clinical documentation. - Identifies barriers utilizing critical thinking skills to identify improvement opportunities, communicate them to the national team, and help facilitate gains in efficiency and appropriate risk score capture. - Leads work groups to develop learning strategies to improve health care delivery performance. - Serves 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. - Identifies opportunities to promote quality. - Shares best practices in risk adjustment across all sites/regions. - Simultaneously manages multiple, complex projects.
BACKGROUND/EXPERIENCE desired:
RN or LPN with current unrestricted state licensure required.
CPC (Certified Professional Coder) certification or CRC (Certified Risk Adjustment Coder) certification required within 6 months of hire Nurses that currently hold the CPC (Certified Professional Coder) certification will be required to obtain the CRC (Certified Risk Adjustment Coder) certification within 6 months post hire
EDUCATION
The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
A licensed is required for this position
Nursing/Registered Nurse (RN) is desired
Nursing/Licensed Practical Nurse (LPN) is desired
Nursing/Licensed Vocational Nurse (LVN) is desired
FUNCTIONAL EXPERIENCES
Functional - Nursing/Quality Management/1-3 Years
Functional - Clinical / Medical/Clinical claim review & coding/1-3 Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User
Local travel between 50% to 60%
Telework within the Nevada and Utah area
ADDITIONAL JOB INFORMATION
Position will require regional travel to Aetnas provider offices, clinics and facilities. - Position requires proficiency with computer skills which include navigating multiple systems and keyboarding. - Effective Communication skills required, both verbal and written. - Ability to multi-task, prioritize and effectively adapt to a fast paced changing environment. - Position is sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone, and typing on the computer. - Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. - Work is performed in a typical office environment with productivity and quality expectations.
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.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Employment Type Regular Career Band Description Professional
Works with internal business partner (specifically the CRMO clinical coding team), to develop relationships with local networks and health care management teams to educate, train, and provide face to face support to physician practice groups who serve our commercial exchange membership (both on and off exchanges, individual and small group clients) in support of risk adjustment.
Local travel between 50% to 60%
Telework within the Nevada and Utah area
Fundamental Components:
Uses clinical skills to assess, plan, monitor and evaluate healthcare services in the provider office setting participating in direct patient care and assessment. - Responsible for educating providers on how to properly document medical services and interventions received during face to face encounters, including proper coding and claim submission for services rendered. - Works on-site in physician offices to assist with scheduling appointments for health risk assessments and other related medical services in support of our commercial exchange members who may have a gap in care. - Serves as a liaison to peers to provide in-depth clinical knowledge and expertise to support the education of providers. - Performs audits of medical records to ensure all assigned ICD-9/10 codes are accurate and supported by written clinical documentation. - Identifies barriers utilizing critical thinking skills to identify improvement opportunities, communicate them to the national team, and help facilitate gains in efficiency and appropriate risk score capture. - Leads work groups to develop learning strategies to improve health care delivery performance. - Serves 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. - Identifies opportunities to promote quality. - Shares best practices in risk adjustment across all sites/regions. - Simultaneously manages multiple, complex projects.
BACKGROUND/EXPERIENCE desired:
RN or LPN with current unrestricted state licensure required.
CPC (Certified Professional Coder) certification or CRC (Certified Risk Adjustment Coder) certification required within 6 months of hire Nurses that currently hold the CPC (Certified Professional Coder) certification will be required to obtain the CRC (Certified Risk Adjustment Coder) certification within 6 months post hire
EDUCATION
The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
A licensed is required for this position
Nursing/Registered Nurse (RN) is desired
Nursing/Licensed Practical Nurse (LPN) is desired
Nursing/Licensed Vocational Nurse (LVN) is desired
FUNCTIONAL EXPERIENCES
Functional - Nursing/Quality Management/1-3 Years
Functional - Clinical / Medical/Clinical claim review & coding/1-3 Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User
Local travel between 50% to 60%
Telework within the Nevada and Utah area
ADDITIONAL JOB INFORMATION
Position will require regional travel to Aetnas provider offices, clinics and facilities. - Position requires proficiency with computer skills which include navigating multiple systems and keyboarding. - Effective Communication skills required, both verbal and written. - Ability to multi-task, prioritize and effectively adapt to a fast paced changing environment. - Position is sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone, and typing on the computer. - Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. - Work is performed in a typical office environment with productivity and quality expectations.
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.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Employment Type Regular Career Band Description Professional
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