Overview

ComplexCare Solutions (CCS) specializes in helping those in need by delivering high value in-home and virtual assessments for health plans nationwide. We pride ourselves on our member engagement aimed towards evaluating current health status, gaps in care, potential health risks and care management opportunities with a focus on driving better clinical outcomes. Our visits give Providers the opportunity to spend a full hour with these members which allows them to capture a comprehensive picture of that individual’s personal needs and what is required to keep them in the home and out of the hospital.

CCS is calling on Nurse Practitioners that are passionate about helping their local communities. We care dearly about those we serve and we need your help to make a difference in the lives of our members.

Responsibilities

• 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.
• Maintain compliance with Inovalon’s policies, procedures and mission statement;
• Adhere to all confidentiality and HIPAA requirements as outlined within Inovalon’s Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position;
• Fulfill those responsibilities and/or duties that may be reasonably provided by Inovalon for the purpose of achieving operational and financial success of the Company;
• Uphold responsibilities relative to the separation of duties for applicable processes and procedures within your job function;
• We reserve the right to change this job description from time to time as business needs dictate and will provide notice of such.
• Other duties as assigned

Qualifications

• Active un-encumbered license to practice nursing;
• Nurse Practitioner Certification from either the ANCC or AANP;
• Maintains current CPR certification (ACLS, BLS - Provider, CPR - Provider or ATLS)
• Compliance, prior to hire, with recommended Healthcare Personnel Requirements for vaccinations and preventive testing:
  • Hepatitis B
  • Influenza
  • MMR: Measles, Mumps and Rubella
  • Pertussis, Tetanus and diphtheria and acellular pertussis (Tdap)
  • Varicella
  • Tuberculosis
• 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.

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