What are the responsibilities and job description for the Nurse Practitioner position at Complex Care Solutions, LLC?
ComplexCare Solutions specializes in delivering high-value, in-home and virtual assessments for health plans nationwide. Our focus is on member engagement to evaluate current health status, gaps in care, potential health risks, and care management opportunities.
We pride ourselves on providing comprehensive assessments that allow healthcare providers to capture a full picture of an individual's personal needs and circumstances.
Our team consists of passionate professionals dedicated to making a difference in the lives of our members. We are seeking Nurse Practitioners who share our commitment to delivering exceptional care and improving clinical outcomes.
The ideal candidate will possess knowledge of CMS Regulations, NCQA HEDIS Guidelines, and evidence-based clinical practice standards. Familiarity with ICD-9, ICD-10, and CPT-4 coding practices is also essential.
Responsibilities
- Conduct thorough reviews of assigned member populations, including timely completion and submission of required encounter documentation.
- Ensure accurate and compliant documentation of pertinent medical conditions in the member's medical record.
- Support the physician-patient relationship through timely and adequate communication, documentation of assessment findings, and recommendations for additional services.
- Address identified gaps in care and make general recommendations to improve members' knowledge of their chronic conditions.
- Recognize emergent or urgent situations requiring escalation and take appropriate action as specified in Inovalon policies.
- Maintain compliance with Inovalon's policies, procedures, and mission statement.
- Adhere to confidentiality and HIPAA requirements at all times.
Qualifications
- Active, unencumbered license to practice nursing.
- Nurse Practitioner Certification from either the ANCC or AANP.
- Board Certified through the AANP or ANCC.
- Maintains current CPR certification.
- Compliance with recommended Healthcare Personnel Requirements for vaccinations and preventive testing.
- Home Health experience is beneficial.
- Ability to effectively communicate with elderly and chronically ill patients and families.
- Understanding of Medicare, Medicaid, and Health Plan benefit structures is beneficial.
- Excellent customer service skills.
