Registered Nurse RN Senior Clinical Coding Nurse Houston Texas
Company: Optum
Location: Sugar Land
Posted on: May 8, 2025
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Job Description:
WellMed, part of the Optum family of businesses, is seeking a RN
to join our team in Houston, T. Optum is a clinician-led care
organization that is changing the way clinicians work and live.
As a member of the Optum Care Delivery team, you'll be an integral
part of our vision to make healthcare better for everyone.
At Optum, you'll have the clinical resources, data and support of a
global organization behind you so you can help your patients live
healthier lives. Here, you'll work alongside talented peers in a
collaborative environment that is guided by diversity and inclusion
while driving towards the Quadruple Aim. We believe you deserve an
exceptional career, and will empower you to live your best life at
work and at home. Experience the fulfillment of advancing the
health of your community with the excitement of contributing new
practice ideas and initiatives that could help improve care for
millions of patients across the country. Because together, we have
the power to make health care better for everyone. Join us and
discover how rewarding medicine can be while Caring. Connecting.
Growing together.
The Sr. Clinical Coding RN Nurse Consultant will drive consistent,
efficient processes and share best practices in a collaborative
effort with Providers and Market Team, designed to facilitate
achievement of goals set for HCC Ratio, HCC Covered Ratio, and HCC
Percent Covered. The Sr. Clinical Coding Nurse Consultant will
drive Risk Adjustment improvement initiatives, develop
recommendations for Risk Adjustment remediation plans and create
tools and databases to capture relevant data for assigned markets
to achieve corporate and market specific Risk Adjustment goals and
initiatives. This position will work collaboratively with each
regional / market team and their leadership in a matrix
relationship. This position will provide direction and guidance to
Medical Coding Analysts, as well as cross functional team members
within their respective Markets pertaining to Risk Adjustment.
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Primary Responsibilities:
Develop and implement market business plans to motivate providers
to engage in improving Risk Adjustment metrics
Provide analytical interpretation of Risk Adjustment reporting
including, Executive Summaries, HCC Ratio, Disagree and Resolution
rates, and FaxBack reporting to plan and provider groups
Subject Matter Expert (SME) for all Risk Adjustment related
activities within their assigned market(s) working within a matrix
relationship which includes DataRAP operations and Regional /
Market operations
Assist in developing of training and analytical materials for Risk
Adjustment
Oversee DataRAP training and education delivery for Mega Groups via
Provider education sessions and Physician Business Meetings /
JOCs
Lead Weekly, Monthly, Bi-monthly, Quarterly, and/or Annual Business
Review meetings related to Risk Adjustment activities which
summarize provider group performance and market performance as
requested by or required by Market leadership
Analyze and evaluate provider group structure and characteristics,
provider group/provider office operations and personnel to identify
the most effective approaches and strategies related to Risk
Adjustment
Analyze Provider and Group performance regarding Risk Adjustment
and Focus on Care (FOC) to determine areas of focus or improvement
opportunities
Develop solution-based, user friendly initiatives to support
practice success
Oversee market specific chart retrieval and review of PCP,
Hospital, and Specialist records
Work with DataRAP Senior Leadership on identified special
projects
This is a Hybrid / Field Base position requiring travel in the
Houston area
In 2011, WellMed partnered with Optum to provide care to patients
across Texas and Florida. WellMed is a network of doctors,
specialists and other medical professionals that specialize in
providing care for more than 1 million older adults with over
16,000 doctors' offices. At WellMed our focus is simple. We're
innovators in preventative health care, striving to change the face
of health care for seniors. WellMed has more than 22,000+ primary
care physicians, hospitalists, specialists, and advanced practice
clinicians who excel in caring for 900,000+ older adults. Together,
we're making health care work better for everyone.
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:
Bachelor's Degree in Nursing -(Associate Degree or Nursing Diploma
from accredited nursing school with 2+ years of additional
experience may be substituted in lieu of a bachelor's degree)
Current unrestricted Texas RN license or compact license
CPC certification or proof that certification has been obtained
within 9 months from the American Academy of Professional
Coders
5+ years of associated business experience with health care
industry
1+ years of ICD-9, ICD10 coding experience
Professional experience persuading changes in behavior
Solid knowledge of the Medicare market, products and
competitors
Knowledge base of clinical standards of care and preventative
health measures
Knowledge of CMS HCC Model and Guidelines along with ICD 10
Guidelines
Ability and willingness to travel (locally and non-locally) as
determined by business needs
Driver's license and access to reliable transportation
Preferred Qualifications:
Undergraduate degree
Experience in managed care working with network and provider
relations
Additional Medical chart review experience
Medical / clinical background highly desirable
MS Office Suite, moderate to advanced Excel and PowerPoint
skills
Demonstrated ability to interact with medical staff, peers, and
internal company staff at all levels
Proven ability to solve process problems crossing multiple
functional areas and business units
Proven solid presentation skills and relationship building skills
with clinical / non-clinical personnel
Proven solid problem-solving skills; the ability to analyze
problems, draw relevant conclusions and devise and implement an
appropriate plan of action
Proven good business acumen, especially as it relates to
Medicare
The salary range for this role is $71,600 to $140,600 annually
based on full-time employment. Pay is based on several factors
including but not limited to local labor markets, education, work
experience, certifications, etc. UnitedHealth Group complies with
all minimum wage laws as applicable. 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.
OptumCare is an Equal Employment Opportunity employer under
applicable law and qualified applicants will receive consideration
for employment without regard to race, national origin, religion,
age, color, sex, sexual orientation, gender identity, disability,
or protected veteran status, or any other characteristic protected
by local, state, or federal laws, rules, or regulations.
OptumCare is a drug-free workplace. Candidates are required to pass
a drug test before beginning employment.
Keywords: Optum, Sugar Land , Registered Nurse RN Senior Clinical Coding Nurse Houston Texas, Healthcare , Sugar Land, Texas
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