Aetna Registered Nurse (RN) - Health Risk Education Consultant in Albuquerque, New Mexico

Req ID: 54461BR


Works with internal business partner (specifically the Medicare Advantage coding team), 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 Advantage membership (both on and off exchanges, individual and small group clients) in support of risk adjustment.

Fundamental Components:

  • 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 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.

  • Uses clinical skills to coordinate, document, and communicate medical services.

  • Conducts assigned retrospective chart reviews and reviews health assessment forms for supportive documentation of ICD-9 ICD-10 codes

  • Serves as the training resource and subject matter expert to regionally aligned network practices.

  • Collects information and coordinates documentation for process improvements at the practice level to improve overall risk adjustment scores and gaps.

  • Shares best practices in risk adjustment across all sites/regions.

  • Participates in work groups to develop learning strategies to improve healthcare delivery performance

  • Simultaneously participates in multiple, projects


  • RN with current unrestricted state license required

  • CPC (Certified Professional Coder) certification or CRC (Certified Risk Adjustment Coder) certification required

  • Nurses that currently hold the CPC (Certified Professional Coder) certification will be required to obtain the CRC (Certified Risk Adjustment Coder) certification within 6 months post hire Nurses that currently hold no coding certification will be required to obtain the CRC (Certified Risk Adjustment Coder) certification within 6 months post-hire

  • 3+ years clinical experience required

  • Minimum of 4 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing

  • Experience with ICD-9 codes required

  • Experience with Medicare and/or Commercial risk adjustment process required

  • Experience/understanding of electronic medical records/electronic health records in the office setting required

  • Knowledge of quality of care and member safety issues


    The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

    Telework Specifications:

    Full-Time Work-at-Home position


    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.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Health Care

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.