[Hiring] Clinical Documentation Integrity Specialist RN @UnitedHealth Group

Role Description

As the Registered Nurse, you will be responsible for effective care delivery and management of patient care within a specialty, utilizing the nursing process and adhering to current standards of nursing practice. You will communicate and coordinate effectively with all entities involved in the care of the patient to promote safe, high-quality care, making decisions that reflect critical thinking and evidence-based nursing practice.

Position Details:

• Location: Remote (MA Residents only)
• Department: Population Health- Risk adjustment
• Schedule: Full time, 40HRS Weekly

If you are a MA resident, you will have the flexibility to work remotely as you take on some tough challenges.

Primary Responsibilities:

• Reviews encounters in the electronic medical record to ensure accuracy and appropriateness of clinician documentation using relevant risk adjustment program standards.
• Utilizes abstract reports to substantiate HCC diagnoses that have been billed and/or are considered relevant but do not appear on the patient’s problem list.
• Provides concurrent and retrospective abstraction for all Reliant Risk Adjustment programs.
• Independently conducts chart reviews for supporting documentation of diagnosis codes which can be added to Problem List.
• Assigns accurate diagnosis codes to Problem List; follows standard work for adding diagnoses to Problem List.
• Reviews new Reliant Medical Group patients for potential diagnoses supporting risk adjustment programs and updates problem list in the electronic medical record.
• With coding education team, provides clinician training for risk adjustment programs. Ad hoc visits to clinical sites may be scheduled to enhance coordination of team-based care and to facilitate clinician education.
• Participates in development, implementation, and monitoring of procedures that support organizational goals and business objectives related to risk adjustment capture.
• Utilizes thorough understanding of CMS/Medicare coding regulations as well as technical knowledge of ICD-10 and CPT systems.
• Performs other duties as assigned.

Qualifications

• Graduate of a State-approved school of nursing.
• Current, unrestricted, license to practice professional nursing in the Commonwealth of Massachusetts.
• Certification as professional coder (CPC, CCS-P, CCS, CPC-H, CRC-risk, AAPC) or ability to obtain certification while working in the position.
• American Heart Association Basic Life Support (BLS).
• 3+ years nursing experience with at least 3 years of clinical experience with chronic disease patient populations in an ambulatory or inpatient setting.

Preferred Qualifications

• Bachelor of Science in Nursing (BSN).
• Advanced Cardiac Life Support (ACLS) may be required based on specialty.
• 2+ years of RN experience in a variety of specialties and multiple diseases within each specialty.
• Computer experience with the ability to use word processing and spreadsheet programs.
• Electronic medical record (EMR) experience and/or aptitude to master the EMR based on other technology experience.
• Proven solid written communication skills.
• Proven solid critical thinking, problem solving, interpersonal and patient interviewing skills.
• Proven ability to interpret clinical information, assess the implication of treatment and develop and implement a plan of care.
• Proven ability to prioritize, multitask, and work in a rapidly changing environment with multiple demands.
• Proven excellence in practice, documentation, and cost-effective care utilization. Maintains high patient satisfaction.

Requirements

• *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Benefits

• Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.
• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
• The hourly pay for this role will range from $29 - $52 per hour based on full-time employment.