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Clinical Coding Nurse Consultant Job in Port Saint Lucie, Florida

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Job Title: Clinical Coding Nurse Consultant

Skills:RN License,CPC Certification
Required Certifications:CPC and RN
Required Experience:3 to 4 years
Preferred Experience:3 to 4 years
Location: Port Saint Lucie 34986, FL, US
Date Posted:5/3/2018

The Clinical Coding Nurse Consultant assists in the development of operational framework focused on scalable and repeatable best practices as it relates to Risk Adjustment both within the DataRAP Department and at the market level.  This position supports and aligns planning to ensure the key strategic rationale for DataRAP is delivered and the associated revenues and cost savings targets are realized. Responsible for working closely with leaders in all markets to ensure Enterprise initiatives related to DataRAP (Risk Adjustment) are implemented and goals are met. The Clinical Coding Nurse Consultant is imbedded in all markets to provide support and education to all market leaders, Providers and clinic staff. This position  identifies, develops and implements simplification and automation to improve the Primary Care Provider (PCP), the market, and ultimately, the member experience.

*This position requires up to 50% travel within the Treasure Coast market 2-3 days per week. Position will be onsite at 585 NW Lake Whitney Place, Port Saint Lucie, FL 34986 when not traveling.*


Primary Responsibilities:

  • Educate practitioners/clinical staff and provide ongoing clinical guidance related to the Risk Adjustment process. Ensure all Market Leaders are utilizing established tools and are able to downstream this education in their prospective markets
  • Work collaboratively with market physician leadership in the development and management, project governance and detailed project plans as it relates to assigned market
  • Partner with corporate leadership to identify the most beneficial options and assist in driving the completion of the selected option
  • Partner with business owners to identify methods to execute upon the key strategic visions and lead the initiative to completion
  • Work with corporate operations to develop program success metrics and ongoing performance metrics
  • Provide strong leadership and judgment; effectively build and deepen relationships across assigned market
  • Create a team-oriented work climate that enables professional development and encourages creative solutions and strategies, establishes collaboration and emphasizes quality and cost
  • Provide leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff
  • Provides educational tools which may include presentations as assigned by management
  • Review and update educational materials as approved by Leadership
  • Perform Clinical Chart Audits as business needs dictate
  • Perform Quality Audits to ensure error rate remains within industry standard
  • Maintain compliance with Optum coding standards and CMS Risk Adjustment guidelines
  • Performs all other related duties as assigned

Required Qualifications:

  • Bachelor’s Degree in Nursing (Associate’s 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 RN license in good standing
  • CPC certification or proof that certification has been obtained within 9 months from the American Academy of Professional Coders
  • 4+ years of General Clinical experience
  • 2+ years of clinical coding experience with strong attention to detail and a high level of accuracy
  • Knowledge of CMS-HCC model and guidelines along with ICD-9/10 and guidelines
  • Ability to speak and provide presentations and education to small and large groups alike
  • Ability to work a flexible work schedule and travel to markets requiring overnight stays
  • Ability and willingness to travel (locally and non-locally) as determined by business need
  • Effectively communicates complex ideas clearly and concisely to internal and external customers
  • Able to create, build and maintain relationships in order to improve performance and establish trust and maintain creditability throughout the organization
  • Demonstrates effective interpersonal, influence, collaboration and listening skills to address complex situations or issues with a high degree of integrity
  • Possess a high tolerance to stress and the ability to handle difficult situations in a confident and diplomatic manner
  • Provide leadership, organization and methodology to a project / operations team
  • Excellent time management, organizational, and prioritization skills and ability to balance multiple priorities and make changes to work as the project needs dictate
  • MS Office Suite experience, moderate to advanced Excel and PowerPoint skills
Physical & Mental Requirements:
  • Ability to lift up to 10 pounds
  • Ability to sit for extended periods of time
  • Ability to use fine motor skills to operate equipment and/or machinery
  • Ability to receive and comprehend instructions verbally and/or in writing
  • Ability to use logical reasoning for simple and complex problem solving

If the hired individual resides in Florida (office based or telecommuting) this position requires the AHCA Level II background check (fingerprinting) by the State of Florida for all clinicians that have direct face to face contact with members OR employees who will have access to confidential patient data and will require renewal every five years.


Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)


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.


Job Keywords: coding, RN, registered nurse, travel, risk adjustment, cpc, certified professional coder, certified coder, Port Saint Lucie, Sebastian, Vero Beach, Fort Pierce


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