ComplexCare Solutions (CCS) excels at delivering high-touch, high-value assessment and care management services for health plans nationwide. We are known for our successful in-home member engagement, which allows us to collect a more robust range of data, implement more personalized care plans and motivate change for desired outcomes.
CCS is seeking Nurse Practitioners to conduct home visits to complete annual health assessments on a member to capture a comprehensive picture of the patient's health status, including the supporting evidence for all medical conditions.
- Knowledge of CMS Regulations and NCQA HEDIS Guidelines;
- Knowledge of Evidence-based Clinical Practice Standards: American Diabetes Association (ADA), American College of Cardiology (ACC), American Heart Association (AHA)Familiarity with ICD-9, ICD-10 and CPT-4 coding practices;
- Complete comprehensive, accurate and thorough review of the assigned member population, including timely completion and submission of all required encounter documentation (paper or electronic);
- Ensure that all pertinent and active medical conditions are documented in the medical record in a manner compliant with CMS/DHHS, Inovalon policy, and client requirements;
- Support the physician/patient relationship and ensure timely and adequate communication, documentation of assessment findings, recommendations, need for additional services, emergency services required if necessary and need for follow up and timelines for follow up to primary care provider (PCP) and health plan as required;
- Make general recommendations to members intended to improve members' knowledge of their chronic condition(s), such as information concerning recommended testing;
- Address and close identified gaps in care (disease-specific or preventive);
- Recognize emergent or urgent situations requiring escalation and take appropriate action as specified in Inovalon policies, and as determined by reasonable professional judgment and ethical professional practice standards; and
- Perform, document and communicate results of Point of Care (POC) Testing.
- Active un-encumbered license to practice nursing;
- Nurse Practitioner Certification from either the ANCC or AANP;
- BCLS (Basic Cardiac Life Support for Healthcare Workers);
- Compliance, prior to hire, with recommended Healthcare Personnel Requirements for vaccinations and preventive testing:
- Hepatitis B
- MMR: Measles, Mumps and Rubella
- Pertussis, Tetanus and diphtheria and acellular pertussis (Tdap)
- Geriatric or adult medicine specialty a plus;
- Must be able to effectively communicate with elderly and chronically ill patients and families;
- Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial;
- Ability to multitask;
- Excellent customer service skills;
- Bi-lingual or multi-lingual a plus.
External Company Name: Complex Care Solutions
External Company URL: https://www.complexcaresolutions.com/