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Rn - Nurse - High Risk Team
Posted on 3/29/2022
INACTIVE
Locations
Atlanta, GA, USA
Experience Level
Entry
Junior
Mid
Senior
Expert
Desired Skills
Management
PowerPoint/Keynote/Slides
Requirements
  • Bachelor's degree in Nursing, Health Information Management or other clinical degree preferred; however, an equivalent combination of education and experience, which provides proficiency in the areas of responsibility, may be substituted for the stated education and experience requirements
  • Minimum 3 years related experience
  • CCS, CCDS or CDIP preferred
  • Knowledge of age-specific needs and the elements of disease processes and related procedures
  • Working Knowledge of the Medicare Advantage reimbursement system and HCC Coding required
  • Working knowledge of HEDIS quality specification
  • Excellent written and verbal communication skills
  • Excellent critical thinking skills
  • Ability to work independently in a time-oriented environment
  • Tech savviness. Strong proficiency in Microsoft Windows, Word, Excel, PowerPoint and the Google suite of products, including Gmail and Calendar
Responsibilities
  • Reviews office notes of patients to identify the diagnoses in the HCC model and to assign a working HCC. Performs initial reviews, concurrent reviews and retrospective reviews to ensure there is adequate supporting documentation for HCC diagnoses in the note
  • Educates internal staff on clinical documentation and coding guidelines. Develops and conducts ongoing CDM education for new staff including coders, providers, nurses, and behavioral health specialists
  • Develops and supports strong professional relationships with medical providers across the system
  • Does review sessions with clinicians in local markets via video or face-to-face when possible
  • Utilizes a compliant query process per guidelines and policy when conducting all queries. Follows each query through to closure including complete documentation of ongoing follow up activities and communication
  • Prospectively generates suspect conditions based on findings from chart review and assists in the creation of decision support logic
  • Works collaboratively with Medicare Risk Operations Medical Director to ensure positive program outcomes
  • Assists in other monitoring activities, special department projects or other needs as determined by the department manager
  • Provide ongoing CDI team learning opportunities through sharing of professional knowledge
  • Maintains integrity and compliance in all chart reviews and CDI documentation and queries at all times
  • Review medical records to identify documentation that supports closure of HEDIS and other quality gaps and with the CP+S/BCI teams to submit to health plans via attestation or electronic filings as appropriate
  • Works closely with Operations Director to implement MRO initiatives
One Medical

1,001-5,000 employees

Primary care quality, experience, and technology.
Company Overview
One Medical is a membership-based primary care platform with seamless digital health and inviting in-office care, convenient to where people work, shop, live and click. Their vision is to delight millions of members with better health and better care while reducing the total cost of care. Their mission is to transform health care for all through their human-centered, technology-powered model. They are disrupting health care from within the existing ecosystem by simultaneously addressing the frustrations and unmet needs of key stakeholders, which include consumers, employers, providers, and health networks.
Benefits
  • Paid sabbatical for your 5th and 10th year
  • Paid health, vision, and dental insurance
  • PTO cash out program lets you get cash for up to 40 accrued PTO hours each year
  • Free One Medical memberships for you and three friends or family members
  • Pre-tax commuter benefits
  • Paid maternity and paternity leave at 100% of your base salary
  • Credit towards childcare