What are the responsibilities and job description for the Nurse Practitioner position at Complex Care Solutions, LLC?
Helping Those in Need: A Comprehensive Approach to Healthcare
About ComplexCare Solutions (CCS)
CSS specializes in delivering high-value in-home and virtual assessments for health plans nationwide. Our member engagement focuses on evaluating current health status, gaps in care, potential health risks, and care management opportunities to drive better clinical outcomes.
Our comprehensive visits give providers the opportunity to spend a full hour with members, capturing their personal needs and requirements to keep them at home and out of the hospital.
We are seeking passionate Nurse Practitioners who want to make a difference in their local communities. At CCS, we care deeply about those we serve and need your help to deliver exceptional care.
Responsibilities
- Knowledge of CMS Regulations and NCQA HEDIS Guidelines;
- Familiarity with ICD-9, ICD-10, and CPT-4 coding practices;
- Conduct comprehensive reviews of assigned member populations, completing accurate and thorough documentation within required timelines;
- Evaluate and document all pertinent medical conditions in compliance with CMS/DHHS, Inovalon policy, and client requirements;
- Support physician-patient relationships through timely communication, documentation of assessment findings, recommendations, and follow-up actions;
- Make recommendations to improve members' knowledge of chronic conditions, including recommended testing;
- Closed identified gaps in care, addressing disease-specific or preventive services;
- Recognize emergent situations requiring escalation and take appropriate action according to Inovalon policies and professional standards;
- Perform, document, and communicate Point of Care (POC) Testing results;
- Maintain compliance with Inovalon's policies, procedures, and mission statement;
- Adhere to confidentiality and HIPAA requirements in all aspects of data handling and service delivery;
- Fulfill additional responsibilities as reasonably provided by Inovalon for operational and financial success;
- Uphold separation of duties for applicable processes and procedures;
- Other duties as assigned.
Qualifications
- Active un-encumbered license to practice nursing;
- Nurse Practitioner Certification from ANCC or AANP in Family, Adult, Gerontology, or Emergency Medicine;
- Board Certified through AANP or ANCC;
- Maintains current CPR certification;
- Compliance 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;
- Home Health experience a plus;
- Effective communication 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;
- Bilingual or multilingual a plus.
