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Opportunities with ProHealth Physicians, part of the Optum family of businesses. When you work at ProHealth Physicians, your contributions directly sustain the health and well-being of our community. Discover high levels of teamwork, robust medical resources and a deep commitment to exceptional care and service. Join a leading community-based medical group and discover the meaning behind Caring. Connecting. Growing together.  

The Nurse Quality/Clinical Educator (Risk Adjustment) will be responsible for the day to day management of Quality programs, initiatives, and reporting as well as for Risk Adjustment activities for ProHealth Physicians providers. The existing quality programs at ProHealth Physicians are recognized as the best in the state by many business partners. In the this Clinical Educator role, you would provide support to the teams implementing and reporting on these programs. The main risk initiatives for the Clinical Educator will be provider education, chart review, and ensuring accurate coding and documentation across the organization. The position requires working with local leaders

Position Details:

• Location: Hybrid, would be required to travel throughout Connecticut to conduct on-site education sessions
• Schedule: Full time, 40 hours/weekly, Monday through Friday, hours between 7:00AM – 5:00PM

If you are located in the state of Connecticut, you will have the flexibility to work from home and the office in this hybrid role* as you take on some tough challenges.

Primary Responsibilities: 

• Work collaboratively with Clinical and technical resources to ensure quality programs are effective and reporting is completed to meet deadlines requirements
• Weekly touch points with practice site resources to support Risk and Quality programs and reporting
• Manage and Monitor program participation and outcomes
• Monitor program reporting regularly to assist practices 
• Act as a Subject Matter Expert on clinical documentation
• Plan, conduct and coordinate all aspects of RA (Risk Adjustment) process evaluation and education to internal partners
• Communicating a comprehensive understanding of Risk Adjustment, Documentation & Coding guidelines
• Analyze reports to identify and report documentation/coding trends to create opportunities for improvement with internal partners
• Ensure provider documentation and diagnostic code selections are appropriate and recommend improvements as necessary
• Continually assess the knowledge and appropriate application of ICD-10 documentation and coding guidelines
• Leverage reporting benchmarks and RA success measures to prioritize efforts
• Demonstrate a professional and effective face to face communication style and address issues as they arise
• Act as a Subject matter expert on Risk platforms and tools  

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: 

• Current, unrestricted RN license for the state of Connecticut
• 1+ years of clinical practice experience, working in a provider / MD office setting
• Experience with Microsoft applications such as Word, Outlook, Excel and PowerPoint
• Ability to travel within Connecticut offices to conduct on-site education sessions

Preferred Qualifications:  

• BSN or MSN
• CPC or CRC certification
• Experience with EMR systems (Allscripts / EPIC)
• 5+ years of clinical practice experience, working in a provider / MD office setting 
• 2+ years of experience working with Risk Adjustment 
• Billing and coding OR medical office management experience
• Familiarity with outpatient / inpatient billing processes
• Solid understanding of coding principles 
• Excellent facilitation, consulting, and delivery of complex content

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

Connecticut Residents Only: The salary range for Connecticut residents is $56,300 to $110,400 annually. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.     

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.