There are more and more opportunities out there for Certified RN-Coders and Certified RN-Auditors. Even without ICD10 implementation last year, we have noticed an increase in companies wanting to advertise on AACCA and RN-Coder websites. Be sure to check this page often for updates!
Manager of Risk Adjustment (RN or LPN)
This is a work at home position for candidates residing in Southern, CA. Candidates must be comfortable traveling between 25%-50% of the time. Ideally looking for candidates that have 2+ years of supervisory experience as well as a background in coding or medical record review.
Key Components of the Clinical Risk Manager Position
• Manager will oversee staff nurses assigned to specific providers who will have direct access and interaction with the physician and office staff. The manager staff monitors access to relevant data; interact with health plan staff and supportive resources.
• Collaborates with field, internal and provider staff to facilitate member access to care/assessment, adherence to best practices, and coordination of services.
• Supports relevant member specific risk data for each assigned provider location and ensures targeted identified gaps in care are addressed in a timely and coordinated manner.
• works collaboratively with the Risk Adjustment, Quality and Network Mgmt. Team to educate and provide feedback to targeted providers.
• QCC is also a resource for correct risk adjustment diagnostic and procedural coding that meets required standards. In addition, the staff will ensure appropriate, timely submission of related risk adjustment data to the organization. In support of the program to monitor encounter data submission to the organization, QCC staff serves as a liaison and resource for the encounter data analysis analyst. The manager may be a resource to the member and provider by providing the appropriate information to facilitate resolution of issues that arise and to positively impact plan perception and member and provider satisfaction.
A. Key Job Responsibilities
i. Monitors provider group assigned involving multiple locations. The following Southern California counties represent the majority of high priority providers: Riverside, San Bernardino, Los Angeles, San Diego & Orange counties.
ii. Ongoing training and orientation.
iii. Manager may gradually add other locations depending on the number of members. In order to maximize effectiveness, the maximum number of members/care coordinator should not exceed 2500.
B. Interfaces with key departments for reporting, technical support, data gathering processes and collection
C. Discuss and provides advice regarding Risk Reports for assigned Medical Groups and selected physicians and members.
BACKGROUND/EXPERIENCE
2+ years of experience in coding or medical record review is required.
2+ years of managerial or supervisory experience is highly preferred
Experience in risk management or risk adjustment is preferred
Experience in a field based role is helpful
Registered Nurse (RN) or Licensed Practical Nurse (LPN) is required.
EDUCATION
The minimum level of education desired for candidates in this position is a GED or High School Diploma.
Telework Specifications:
Full-Time Telework (WAH)
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Key Components of the Clinical Risk Manager Position
• Manager will oversee staff nurses assigned to specific providers who will have direct access and interaction with the physician and office staff. The manager staff monitors access to relevant data; interact with health plan staff and supportive resources.
• Collaborates with field, internal and provider staff to facilitate member access to care/assessment, adherence to best practices, and coordination of services.
• Supports relevant member specific risk data for each assigned provider location and ensures targeted identified gaps in care are addressed in a timely and coordinated manner.
• works collaboratively with the Risk Adjustment, Quality and Network Mgmt. Team to educate and provide feedback to targeted providers.
• QCC is also a resource for correct risk adjustment diagnostic and procedural coding that meets required standards. In addition, the staff will ensure appropriate, timely submission of related risk adjustment data to the organization. In support of the program to monitor encounter data submission to the organization, QCC staff serves as a liaison and resource for the encounter data analysis analyst. The manager may be a resource to the member and provider by providing the appropriate information to facilitate resolution of issues that arise and to positively impact plan perception and member and provider satisfaction.
A. Key Job Responsibilities
i. Monitors provider group assigned involving multiple locations. The following Southern California counties represent the majority of high priority providers: Riverside, San Bernardino, Los Angeles, San Diego & Orange counties.
ii. Ongoing training and orientation.
iii. Manager may gradually add other locations depending on the number of members. In order to maximize effectiveness, the maximum number of members/care coordinator should not exceed 2500.
B. Interfaces with key departments for reporting, technical support, data gathering processes and collection
C. Discuss and provides advice regarding Risk Reports for assigned Medical Groups and selected physicians and members.
BACKGROUND/EXPERIENCE
2+ years of experience in coding or medical record review is required.
2+ years of managerial or supervisory experience is highly preferred
Experience in risk management or risk adjustment is preferred
Experience in a field based role is helpful
Registered Nurse (RN) or Licensed Practical Nurse (LPN) is required.
EDUCATION
The minimum level of education desired for candidates in this position is a GED or High School Diploma.
Telework Specifications:
Full-Time Telework (WAH)
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Please apply at https://sjobs.brassring.com/TGWebHost/home.aspx?partnerid=25276&siteid=5012 and use Req # 25415BR
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Risk Adjustment Nurse (RN or LPN)
This is a fulltime work at home position and does require up to 25% local travel. Candidates can reside in Southern California or in Washington. Qualified candidates will hold their RN or LPN license and have a minimum of 1 year of medical record review, diagnosis coding or auditing experience.
POSITION SUMMARY
Work with internal business partners specifically with the CRMO clinical coding team - to develop relationships with local network and health care management teams to educate, train, and provide face to face support to physician practice groups who serve our commercial exchange membership (on and off exchange IVL and SG) in support of risk adjustment. RN or LPN with current unrestricted state licensure required.
Fundamental Components:
- Traveling on-site to physician offices to assist with scheduling appointments for health risk assessments and other related medical services in support of our commercial exchange members who may have a gap in care.
- Focus of role is to educate providers on how to properly document medical services and interventions received during face to face member encounters.
- This documentation includes proper coding and claim submission for services rendered.
- Will perform audits of medical records to ensure all assigned ICD-9 codes are accurate and supported by written clinical documentation.
- Serves as the training resource and subject matter expert to regionally aligned network practices.
- Identifies and recommends opportunities for process improvements at the practice level to improve overall risk adjustment scores and gaps.
- Shares best practices in risk adjustment across all sites/regions.
- Participates in workgroups to develop learning strategies to improve healthcare delivery performance
- Simultaneously manage multiple, complex projects
BACKGROUND/EXPERIENCE
Knowledge of regulatory/accreditory guidelines, quality of care and member safety issues
Min 1 year recent experience in medical record review, diagnosis coding, and/or auditing is required.
CPC (Certified Professional Coder) or CCS-P (Certified ICD-9 Coding Specialist-Physician)is preferred
Exp with Medicare and/or Commercial risk adjustment process
Exp/understanding of electronic medical & health records
EDUCATION
The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.
ADDITIONAL JOB INFORMATION
This position will require regional travel to Aetna's provider offices, clinics, and facilities. Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
POSITION SUMMARY
Work with internal business partners specifically with the CRMO clinical coding team - to develop relationships with local network and health care management teams to educate, train, and provide face to face support to physician practice groups who serve our commercial exchange membership (on and off exchange IVL and SG) in support of risk adjustment. RN or LPN with current unrestricted state licensure required.
Fundamental Components:
- Traveling on-site to physician offices to assist with scheduling appointments for health risk assessments and other related medical services in support of our commercial exchange members who may have a gap in care.
- Focus of role is to educate providers on how to properly document medical services and interventions received during face to face member encounters.
- This documentation includes proper coding and claim submission for services rendered.
- Will perform audits of medical records to ensure all assigned ICD-9 codes are accurate and supported by written clinical documentation.
- Serves as the training resource and subject matter expert to regionally aligned network practices.
- Identifies and recommends opportunities for process improvements at the practice level to improve overall risk adjustment scores and gaps.
- Shares best practices in risk adjustment across all sites/regions.
- Participates in workgroups to develop learning strategies to improve healthcare delivery performance
- Simultaneously manage multiple, complex projects
BACKGROUND/EXPERIENCE
Knowledge of regulatory/accreditory guidelines, quality of care and member safety issues
Min 1 year recent experience in medical record review, diagnosis coding, and/or auditing is required.
CPC (Certified Professional Coder) or CCS-P (Certified ICD-9 Coding Specialist-Physician)is preferred
Exp with Medicare and/or Commercial risk adjustment process
Exp/understanding of electronic medical & health records
EDUCATION
The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.
ADDITIONAL JOB INFORMATION
This position will require regional travel to Aetna's provider offices, clinics, and facilities. Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Please apply at https://sjobs.brassring.com/TGWebHost/home.aspx?partnerid=25276&siteid=5012 and use Req # 25270BR
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