1+ months

Be a Risk Adjustment Clinical Educator with Optum - Albuquerque, NM - 908368

Albuquerque, NM 87102
  • Job Code
    908368
Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

The Clinical Educator is responsible for the delivery and implementation of all clinical education materials and initiatives to employed and contracted providers, as well as KPIs within their region designed to ensure appropriate practices related to risk adjustment activities, HEDIS measures, and any appropriate gaps in care. The Clinical Educator is also responsible for overseeing the work of the Physician Chart Reviews to inform primary care providers of potential inferred, embedded, out of date, inaccurate, and/or missed diagnoses not previously identified, and aid in the education and discovery of opportunities for improved quality of care and compliance through accurate coding and documentation. The Clinical Educator is further responsible for keeping up to date on changes in the Medicare risk adjustment model or other documentation requirements.

The Clinical Educator works collaboratively with the Regional Medical Director, Risk Adjustment program director, other Clinical Educators, coding department, lead physicians, site administrators, primary care physicians, specialists, surgeons, and hospitalists to educate on and improve accurate coding and documentation skills, leading to a more complete patient record.

Primary Responsibilities:
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  • Serves as a resource for the region, network, and national operations on proper coding and documentation
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  • Provides education to employed and contracted physicians, PAs, and ARNPs on appropriate supporting documentation, assists in workflow development when requested, and ensures compliant documentation standards are met
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  • Recommends ongoing chart review process to ensure continued high standards in documentation and coding
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  • Oversees the Physician Chart Review Team
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  • Onboarding, ongoing, and targeted education of all physicians on coding and documentation for Medicare risk adjustment
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  • Be accountable for the overall improvement and performance in risk adjustment, HEDIS and any appropriate gaps in care metrics
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  • Attends network and clinic site meetings as appropriate to present material on coding and documentation
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  • Reviews charts to aid in the education process, and discovers opportunities for improve accurate coding and documentation
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  • Attends courses as needed to improve knowledge of coding and documentation
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  • Meets regularly with Regional Risk Adjustment Physician Director; sends updates on activities weekly to network risk adjustment leadership and clinical operations teams
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  • Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each and every internal and external customer
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  • Implements programs designed to ensure all diagnosed codes and conditions are properly supported by appropriate documentation in patient chart. Programs include, but are not limited to, training and educational activities and coordination of random targeted documentation audits and concurrent follow up feedback
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  • Meets with Regional Medical Director to assist in identification of operational and clinical best practices in maximizing patient visits, re-evaluation rates and accurate and proper coding; assists in the dissemination of best practices to sites, clinicians and IPAs providers / support staff
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  • Teaches clinicians in group settings the general principles on documentation and coding
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  • Engages clinicians on continuous dialogue regarding optimizing coding and documentation and associated workflows
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  • Creates and modifies the curriculum for mentoring, small group education, and large group education sessions
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  • Attends and participates as requested in regional and corporate meetings that pertain to coding and documentation
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  • Attends courses as needed to improve/maintain current up to date knowledge of coding and documentation
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  • Maintains knowledge around year over year changes to risk adjustment model
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  • Assists in sharing of best practices related to risk adjustment activities with other regions within the network
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  • Completes annual compliance training on HIPAA / Privacy / Confidentiality / Non-Discrimination / Harassment / Integrity Statement and signs Agreements
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  • Ensures confidentiality of patient information following HIPAA guidelines and company policies
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  • Attends documentation and coding training and integrates learnings into chart review processes
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  • Attends training to meet requirements of the job position and as needed or mandated by company policies, Div. of Occupational Safety & Health (DOSH), OSHA, L&I and other state / federal regulations
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  • Uses, protects, and discloses Optum's patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
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  • Assists Risk Adjustment Director in meeting compliance and regulatory standards
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  • Performs additional duties as assigned

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:
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  • Current and unrestricted license to practice medicine in New Mexico
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  • Advanced degree as a MD, DO, NP, or PA
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  • 2+ years of experience as a primary care physician, NP or PA
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  • Experience in chart review and documentation inside an Electronic Medical Record (EMR)
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  • Ability to analyze and interpret data
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  • Knowledgeable in Microsoft Word, Excel and PowerPoint
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  • Excellent range of knowledge with respect to the practice of medicine; ability to speak clearly and communicate with patients, families, agencies, other providers and staff regarding patient care
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  • You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role
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  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
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Preferred Qualifications:
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  • Excellent verbal and written communication skills; ability to effectively interface with teammates and clinicians
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  • Ability to develop positive interaction with patients, families, physicians, administrators and co-workers in order to effectively care for the patient
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  • Ability to work independently
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Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
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Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers 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.
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Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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Job Keywords: Clinical Educator, Risk Adjustment, Medicine, MD, DO, NP, PA, Primary Care Physician, Chart Review, Documentation, Electronic Medical Record, EMR, Patient Care, Albuquerque, NM, LDMG, LDMG NM, New Mexico

Categories

Posted: 2021-01-13 Expires: 2021-05-16

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Be a Risk Adjustment Clinical Educator with Optum - Albuquerque, NM - 908368

UnitedHealth Group
Albuquerque, NM 87102

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