Registered Nurse (RN) Provider Educator

Description

The Why Behind Wellvana:  

The healthcare system isn’t designed for health. We’re designed to change that.  We’re Wellvana, and we help doctors deliver life-changing healthcare.   

Through our elevated value-based care programs, we’re revitalizing an antiquated system that’s far too long relied on misaligned incentives that reward quantity of care not the quality of it.  

Our enlightened approach—covering everything from care coordination to clinical documentation education to marketing— ties the healthy outcomes of patients directly to shared savings for primary care providers, health systems and payors.   

Providers in our curated network keep their independence, reduce their administrative headaches, and spend more time with patients. Patients, in turn, get an elevated experience with coordinated care between appointments that is nothing short of life-changing.   

Named a 2024 "Best in Business" and 2023 "Best Place to Work" by Nashville Business Journal, we’re one of the fastest-growing healthcare companies in America because what we do works. This is the way medicine is meant to be.  

Clarity on the Role: 

The RN Provider Educator partners with Wellvana affiliated practices and health systems on all aspects of risk adjustment coding, regulatory requirements, and proper documentation procedures for attributed patients in Medicare Advantage, MSSP, and ACO Reach programs. The RN Provider Educator will be responsible for reviewing clinical data and available patient documentation to confirm patient diagnoses in advance of in office physician visits.  Key to this process is personalizing individual physician and practice feedback and to Identify coding trends and documentation patterns from data retrieved by coding reviews and audits. ?The RN Provider Educator must have a thorough understanding of the mechanics of risk adjustment coding and HCC Risk Adjustment Model Categorical Hierarchy and be able to communicate this knowledge effectively to physicians and their practice leaders.  Maintaining a comprehensive schedule and visit log is crucial as is the documentation, and storage, of all materials utilized in practice and health system discussions. The RN Provider Educator is responsible for building positive relationships with assigned Physicians and serves as a key point of contact for any questions or concerns that may arise.  

What's Expected: 

• Thorough understanding of the industry rules and regulations and particularly the mechanics of risk adjustment coding and HCC Risk Adjustment Model Categorical Hierarchy, open condition reporting, identifying unreported conditions, readdressing open chronic conditions 
• Demonstrated ability to communicate this knowledge effectively to physicians and their practice leaders.   
• Expertise in Prospective, Retrospective, and Concurrent review processes 

Organization and Initiative 

• Effectively coordinate and schedule visits with practices, prepare and distribute practice specific materials timely (e.g., minimum of 48 business hours in advance), conduct education sessions, document follow-ups, and store corresponding materials in central repository 
• Identify any error trends in provider clinical documentation and coding by analyzing data derived from coding reviews and internal audits results.  
• Construct training materials utilizing internal standards and insights from respective practice data sets and reviews. Consult with providers and billing staff to correct errors found.? 
• Escalate to leadership if practices do not respond accordingly to meeting requests or follow-ups, or if practice is not adhering to clinical documentation and risk adjustment guidelines 
• Attention to detail to maintain a practice schedule, visit and travel log to document and track all practice outreach, engagement and to organize and file specific materials utilized in education sessions 
• Distribute company provided educational materials and coding tools to guide providers to utilize Wellvana technology and solutions to manage their clinical documentation activities.? 
• Complete practice, or function, special projects as assigned by leadership 

Practice Relationship Management 

• Build and maintain professional relationships with providers and their staff within assigned region, performing monthly in person, or virtual, visits to assigned offices?depending on practice size, location and practice’s demonstrated understanding of clinical documentation guidelines. 
• Ability to collaborate with practices to review patient medical records on a timely basis in advance of upcoming patient visits. 
• Monitor Prospective and Concurrent workflow adoption