What are the responsibilities and job description for the Nurse Practitioner position at Complex Care Solutions, LLC?
**Helping Those in Need**
ComplexCare Solutions (CCS) specializes in delivering high-value in-home and virtual assessments for health plans nationwide.
We pride ourselves on our member engagement, which focuses on evaluating current health status, gaps in care, potential health risks, and care management opportunities to drive better clinical outcomes.
Our visits provide Providers with the opportunity to spend a full hour with members, capturing a comprehensive picture of their personal needs and requirements to keep them at home and out of the hospital.
Passionate About Making a Difference
CSS is seeking Nurse Practitioners who are passionate about helping their local communities. We care deeply about those we serve and need your help to make a positive impact in the lives of our members.
Responsibilities
- Knowledge of CMS Regulations and NCQA HEDIS Guidelines;
- Familiarity with evidence-based clinical practice standards, including American Diabetes Association (ADA), American College of Cardiology (ACC), and American Heart Association (AHA) guidelines;
- Understanding of ICD-9, ICD-10, and CPT-4 coding practices;
- Completing comprehensive, accurate, and thorough reviews of assigned member populations, including timely completion and submission of all required encounter documentation;
- Ensuring that all pertinent and active medical conditions are documented in the medical record in compliance with CMS/DHHS, Inovalon policy, and client requirements;
- SUPPORTING THE PHYSICIAN/PATIENT RELATIONSHIP AND COMMUNICATING EFFECTIVELY WITH MEMBERS;
- Making general recommendations to members to improve their knowledge of chronic conditions and address identified gaps in care;
- Recognizing emergent or urgent situations requiring escalation and taking appropriate action as specified in Inovalon policies and professional judgment;
- Performing, documenting, and communicating results of Point of Care (POC) Testing;
- Maintaining compliance with Inovalon's policies, procedures, and mission statement;
- Adhering to confidentiality and HIPAA requirements; and
- Upholding responsibilities relative to the separation of duties for applicable processes and procedures within your job function.
Qualifications
- An active, unencumbered license to practice nursing;
- Nurse Practitioner Certification from either the ANCC or AANP, with board certification in Family, Adult, Gerontology, or Emergency Medicine;
- Maintaining current CPR certification;
- Compliance with recommended Healthcare Personnel Requirements for vaccinations and preventive testing (Hepatitis B, Influenza, MMR, Pertussis, Tetanus, Varicella, and Tuberculosis);
- Home Health experience preferred;
- The ability to effectively communicate with elderly and chronically ill patients and families;
- Understanding of Medicare, Medicaid, and Health Plan benefit structures beneficial;
- The ability to multitask and provide excellent customer service skills;
- Bi-lingual or multi-lingual a plus.
