Clinical Coding Nurse Consultant - Tampa, FL

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm)
 
Clinical Coding Nurse Consultant assists in the development of operational framework focused on scalable and repeatable best practices as it relates to Risk Adjustment both within the DataRAP Department and at the market level.  This position supports and aligns planning to ensure the key strategic rationale for DataRAP is delivered and the associated revenues and cost savings targets are realized. Responsible for working closely with leaders in all markets to ensure Enterprise initiatives related to DataRAP (Risk Adjustment) are implemented and goals are met. The Clinical Coding Nurse Consultant is imbedded in all markets to provide support and education to all market leaders, Providers and clinic staff. This position identifies, develops and implements simplification and automation to improve the Primary Care Provider (PCP), the market, and ultimately, the member experience.
 
Primary Responsibilities:


Educate practitioners / clinical staff and provide ongoing clinical guidance related to the Risk Adjustment process. Ensure all Market Leaders are utilizing established tools and are able to downstream this education in their prospective markets

Work collaboratively with market physician leadership in the development and management, project governance and detailed project plans as it relates to assigned market

Partner with corporate leadership to identify the most beneficial options and assist in driving the completion of the selected option

Partner with business owners to identify methods to execute upon the key strategic visions and lead the initiative to completion

Work with corporate operations to develop program success metrics and ongoing performance metrics

Provide strong leadership and judgment; effectively build and deepen relationships across assigned market

Create a team-oriented work climate that enables professional development and encourages creative solutions and strategies, establishes collaboration and emphasizes quality and cost

Provide leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff

Provides educational tools which may include presentations as assigned by management

Review and update educational materials as approved by Leadership

Perform Clinical Chart Audits as business needs dictate

Perform Quality Audits to ensure error rate remains within industry standard

Maintain compliance with Optum coding standards and CMS Risk Adjustment guidelines

Performs all other related duties as assigned

Required Qualifications:


Bachelor’s Degree in Nursing required (Associate’s Degree or Nursing Diploma from accredited nursing school with 2 or more years of additional experience may be substituted in lieu of a bachelor’s degree) and current RN license in good standing

CPC certification or proof that certification has been obtained within 9 months from the American Academy of Professional Coders

4 - 5 years of General Clinical experience

Two years of clinical coding experience with strong attention to detail and a high level of accuracy

Knowledge of CMS - HCC model and guidelines along with ICD - 9 10 and guidelines

Ability to speak and provide presentations and education to small and large groups alike

Provide leadership, organization and methodology to a project / operations team

Ability to work a flexible work schedule and travel to markets requiring overnight stays

Ability and willingness to travel (locally and non - locally) as determined by business need

MS Office Suite, moderate to advanced EXCEL and PowerPoint skills 

90% travel

This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor’s diagnosis of disease 
Preferred Qualifications:


Bachelor’s degree

More than two years coding experience

Additional Quality Assurance auditing experience

Additional Chart Review Experience
If the hired individual resides in Florida (office based or telecommuting) this position requires the AHCA Level II background check (fingerprinting) by the State of Florida for all clinicians that have direct face to face contact with members OR employees who will have access to confidential patient data and will require renewal every five years.
  
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi - specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
 
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
 UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
   
 
Job Keywords: Clinical, RN coding, Tampa, Florida, FL