JOB TITLE: Clinical Educator, Population Health
REPORTS TO: Network Medical Director
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for performing comprehensive chart reviews to inform primary care providers of potential inferred, embedded, out of date, inaccurate, and/or missed diagnoses not previously identified and aid in the education and discovery of opportunities for improved quality of care and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 Network 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.
- Serve as a resource for the region, network, and national operations on proper coding and documentation.
- 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.
- Recommends ongoing chart review process to ensure continued high standards in documentation and coding.
- Responsible for onboarding, ongoing, and targeted education of all physicians on coding and documentation for Medicare risk adjustment.
- Be accountable for the overall improvement and performance in risk adjustment, HEDIS and any appropriate gaps in care metrics.
- Attend network and clinic site meetings as appropriate to present material on coding & documentation.
- Review charts to aid in the education process, and discover opportunities to improve accurate coding and documentation.
- Attend courses as needed to improve knowledge of coding and documentation.
- Meet regularly with Network Medical Directors in assigned Pod(s); send updates on activities weekly to network risk adjustment leadership and clinical operations teams.
- Consistently exhibits behavior and communication skills that demonstrate OptumCare’s commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
- 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.
- Meets with Network 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.
- Teaches clinicians in group settings the general principles on documentation and coding.
- Engages clinicians on continuous dialogue regarding optimizing coding and documentation and associated workflows.
- Attends and participates as requested in regional and corporate meetings that pertain to coding and documentation.
- Attends courses as needed to improve/maintain current up to date knowledge of coding and documentation
- Maintains knowledge around year over year changes to risk adjustment model.
- Assists in sharing of best practices related to risk adjustment activities with other regions within the network.
- Completes annual compliance training on HIPAA/ Privacy/ Confidentiality/ Non-Discrimination/ Harassment/ Integrity Statement and signs Agreements.
- Ensures confidentiality of patient information following HIPAA guidelines and company policies.
- Attends documentation and coding training and integrate learnings into chart review processes.
- 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.
- Uses, protects, and discloses OptumCare’s patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
- Assist Risk Adjustment Director in meeting compliance and regulatory standards
- Performs additional duties as assigned.
EDUCATION: Minimum qualifications include an advanced degree as a Nurse Practitioner (ARNP or DNP).
- Current and unrestricted license to practice medicine in Washington State.
- Current and unrestricted DEA certificate.
- Minimum two years experience as a primary care clinician (preferred).
- Experience in chart review and documentation inside an Electronic Medical Record (EMR).
ESSENTIAL TECHNICAL/MOTOR SKILLS:
- 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.
- Ability to develop positive interaction with patients, families, physicians, administrators and co-workers in order to effectively care for the patient.
PHYSICAL REQUIREMENTS IN ACCORDANCE WITH ADA:
- Carrying/Lifting: Occasional / 0-10 lbs
- Standing: Constant / Up to 10 hours per day
- Sitting: Constant / Up to 10 hours per day
- Walking: Constant / Up to 10 hours per day
- Repetitive Motion: Keyboard activity, telephone use, writing
- Visual Acuity: Ability to view computer monitor and read newsprint with or without corrective lenses
- Environmental Exposure: None
Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
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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. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.