Opportunities with Reliant Medical Group, part of the Optum family of businesses. Join a community-based, multi-specialty, physician-led organization where you will work with talented peers on a common purpose: improving the quality, cost and experience of health care. Here, we focus on delivering the best patient care, rather than volume. Through innovation and superior care management, we support patients and your well-being as a team member. Join a team at the forefront of value-based care and discover the meaning behind Caring. Connecting. Growing together. 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. Communicates and coordinates effectively with all entities involved in the care of the patient to promote safe, high quality care. Making decisions reflecting 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 objective 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 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.
Optum Home & Community Care is part of UnitedHealth Group and provides telephonic case management services to help members navigate the health care system and access support services. As an RN Case Manager, you would assess members' health status, identify gaps in treatment plans, establish care goals, coordinate with multidisciplinary teams including mental health clinicians, provide patient education and coaching, make referrals to community resources, and facilitate transitions between care settings—primarily through phone calls in a high-volume customer service environment.
