UnitedHealth Group Nurse Practitioner Clinical Performance Educator - Tucson, AZ in Tucson, Arizona

The Nurse Practitioner Clinical Performance Educator is an Advanced Practice Nurse who has completed the course study of said title and obtained the licensure requirements for the state of Arizona. The NP Clinical Performance Educator has demonstrated successful clinical practice experience to assess patients of senior age groups and has prior recognized capability to confirm prior diagnosis and evaluate treatment plans. The NP Clinical Performance Educator will assess the technical accuracy, specificity, and completeness of provider clinical documentation to identify if clinical findings suggest the presence of other conditions that are not explicitly documented.

The NP Clinical Performance Educator will communicate with providers and other clinical professionals to improve documentation to achieve completeness, technical accuracy, and specificity resulting in accurate HCC (Hierarchical Condition Category) coding.

If you are located in Tucson, Arizona region , you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Analyze provider clinical documentation to determine if requirements for ICD-10 and HCC diagnosis are being met and whether additional documentation would support more specific diagnoses

  • Confirm chronic conditions from patient-specific lists of historical conditions; confirm plan of care developed for patients seen in the primary care clinic

  • Communicate documentation quality assessment findings with individual providers and serve as mentor/resource on documentation and HCC coding issues and questions

  • Provide education sessions on clinical documentation, HCC coding, and RAF scoring to providers in a 1:1 or group setting as needed

  • Report results of documentation assessment findings, results of ongoing mentoring with CDQI executive leadership

Required Qualifications:

  • Completed required training course for the practice of advanced nursing in accordance with the Arizona Board of Nursing for their state of residency

  • Active,unrestricted Arizona license in area of practice or ability to obtain

  • NP certification through ANCC or AANP or ability to obtain

  • 2+ yrs clinical experience as an NP or will consider 3+ yrs. of previous RN experience in acute care setting (preferably in intensive, critical care or skilled nursing)

  • Ability to formulate a differential diagnosis and assign ICD-10 diagnosis code to highest level of specificity

  • Proficient in assessment and development of treatment plans and associated clinical documentation requirements

  • Familiarity with health conditions frequently found in 65+ aged population

  • Ability to conceptualize the needs for the team or department and actualize plans for implementation

  • Empowered to develop plans of action and gain team consensus towards common goals

  • Ability to review and analyze data in Excel and other software packages

  • Ability to communicate with and provide feedback to primary care physicians and management staff

  • Ability to make care decisions based on best medical practices without direct supervision or guidance by a physician

  • Ability to provide in person provider documentation training and mentoring and web based learning in settings ranging from 1:1 to large group

  • Basic technical proficiency in the use of computer programs for medical records or internet search for clinical practice

Preferred Qualifications:

  • Past experience with Clinical Documentation Improvement and Provider Education

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.