RN ACO Provider Educator & Clinical Reviewer

Why ThedaCare?   

Living A Life Inspired!

Our new vision at ThedaCare is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care, lower costs and a healthier future for our patients, our families, our communities and our world. 

At ThedaCare, our team members are empowered to be the catalyst of change through our values of compassion, excellence, leadership, innovation, and agility.  A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you’re interested in joining a health care system that is changing the face of care and well-being in our community, we encourage you to explore a future with ThedaCare.

Benefits, with a whole-person approach to wellness –

• Lifestyle Engagement
  • e.g. health coaches, relaxation rooms, health focused apps (Wonder, Ripple), mental health support  

• Access & Affordability
  • e.g. minimal or zero copays, team member cost sharing premiums, daycare

About ThedaCare!

Summary :

The ACO Clinical Reviewer performs outpatient and inpatient chart reviews to maximize ThedaCare ACO’s value-based performance opportunities. Reviews clinical documentation for diagnosis coding accuracy. Collects and submits reliable clinical data to primary care and specialist providers for educations purposes. Works closely with leaders, independent and employed practice leaders, providers, coders, and ThedaCare quality to identify and implement opportunities for improving clinical quality, efficiency, and reduction of total cost of care.

Job Description:

Schedule can be flexible hours, but is 40 hours per week. No weekends/call/holidays

Key Accountabilities

• Reviews hierarchical condition category (HCC) coding accuracy in existing clinical documentation and identifies and validates HCC coding recapture opportunities for Medicare and Medicare Advantage patients.

• Prepares specialty specific education materials and leads educational sessions in both 1:1 and group formats with both employed and affiliated physicians, Leaders and other clinical team members on HCC coding and documentation requirements. 

• Serves as an operational leader and subject matter expert to the HCC Vendors, providing oversight and performing testing and validation for accuracy of HCC recapture tools.

• Collaborates with multidisciplinary team to gather accurate and complete clinical picture to ensure clinical documentation and diagnosis coding accurately reflects the true illness burden of the ACO’s attributed patient populations.  Communicates and collaborates with physician coding team to ensure accurate code assignment.

• Reviews patient medical records for outpatient, inpatient and transitional care services as part of defined value-based performance improvement initiatives.

• Prepares and disseminates reports illustrating trends in the HCC score and recapture.

• Works closely with information technology to implement EPIC functionality to providers.

Qualifications

• Bachelor’s degree in nursing

• Three (3) years’ experience in an outpatient and/or inpatient clinical role involving direct patient care and/or patient chart review, abstraction, etc.

• Registered Nurse (RN)

• Certified Clinical Documentation Specialist or similar certification within three years of hire

Physical Demands

• Ability to move freely (standing, stooping, walking, bending, pushing and pulling) and lift up to a maximum of twenty-five (25) pounds without assistance

• Job classification is not exposed to blood borne pathogens (blood or bodily fluids) while performing job duties

Work Environment

• Normally works in climate-controlled office environment

• Frequent sitting with movement throughout office space

• Use of computers throughout work day

• Frequent use of keyboard with repetitive motion of hand