Remote Health Risk Education Consultant RN LPN

CVS Health

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Job ID: R0011584
Category: Clinical Services
Remote: Fully Remote

Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

 

 

This is a full-time telework position open to qualified candidates throughout the United States.

 

Hours for this position are Monday-Friday 8:00a-5:00p EST.

 

Position Summary
Works with internal business partners 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 Medicare membership
in support of risk adjustment.

 

Uses clinical skills to assess, plan, monitor, and evaluate healthcare services
in the provider office setting – participating in direct patient care and
assessment. Responsible for educating providers on how to properly
document medical services and interventions received during face to face
member encounters, including proper coding and claim submission for
services rendered. Works remotely and/or on-site in physician offices to assist with scheduling appointments for health risk assessments and other related
medical services in support of our Medicare members who may
have a gap in care. Serves as a liaison to peers to provide in-depth clinical
knowledge and expertise to support the education of providers. Performs
audits of medical records to ensure all assigned ICD-10 codes are accurate
and supported by written clinical documentation. Identifies barriers utilizing
critical thinking skills to identify improvement opportunities, communicate
them to the national team, and help facilitate gains in efficiency and
appropriate risk score capture. Leads work groups to develop learning
strategies to improve health care delivery performance. 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. Identifies opportunities to promote quality. Shares best
practices in risk adjustment across all sites/regions. Simultaneously
manages multiple, complex projects.

 

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. Effective communication skills
required, both verbal and written. Ability to multi-task, prioritize and
effectively adapt to a fast paced changing environment Position is
sedentary work involving periods of sitting, talking, listening. Work requires
sitting for extended periods, talking on the telephone, and typing on the
computer. Work requires the ability to perform close inspection of hand
written and computer generated documents as well as a PC monitor. Work
is performed in a typical office environment with productivity and quality
expectations.

Required Qualifications

  • CPC (Certified Professional Coder) certification required
  • CRC (Certified Risk Adjustment Coder) certification required
  • 4+ years recent experience in medical record documentation review, diagnosis coding, and/or auditing
  • 1+ year(s) of experience with ICD-10 codes
  • Must have active and unrestricted RN or LPN licensure in state of residence
  • 1+ year(s) of experience with Medicare and/or Commercial risk adjustment process
  • Experience/understanding of electronic medical records/electronic health records in the office setting.

Preferred Qualifications

  • 3+ years clinical experience
  • Medicare Stars experience
  • Knowledge of Medicare regulatory/accreditory guidelines

Education

  • Bachelor’s degree OR equivalent recent and related work experience
  • RN/LPN or higher

 

Pay Range

The typical pay range for this role is:

 

$52,520.00 – $113,360.00

 

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  

For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

 

 

 

CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

 

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

 

CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health colleagues can initiate a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through myHR (1-888-694-7287, or through myLeave at myHR). If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.