What are the responsibilities and job description for the Nurse Practitioner position at Complex Care Solutions, LLC?
About Us
ComplexCare Solutions 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.
We pride ourselves on providing comprehensive assessments that allow Providers to spend a full hour with members, capturing their personal needs and what's required to keep them at home and out of the hospital.
Our Mission
We care deeply about those we serve and need your help to make a difference in their lives. As a Nurse Practitioner, you'll have the opportunity to work with local communities and contribute to our mission of improving healthcare outcomes.
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), and American Heart Association (AHA);
- Familiarity with ICD-9, ICD-10, and CPT-4 coding practices;
- Complete comprehensive, accurate, and thorough reviews of assigned member populations, including timely completion and submission of all required encounter documentation (paper or electronic);
- Evaluate and document pertinent and active medical conditions in compliance with CMS/DHHS, Inovalon policy, and client requirements;
- Support physician/patient relationships and ensure timely communication, documentation of assessment findings, recommendations, and follow-up actions;
- Make general recommendations to improve members' knowledge of chronic conditions, such as recommended testing;
- Closure of 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 professional standards;
- Perform, document, and communicate results of Point of Care (POC) Testing;
- Maintain compliance with Inovalon's policies, procedures, and mission statement;
- Adhere to confidentiality and HIPAA requirements; and
- Perform other duties as assigned.
Qualifications
- Active, unencumbered nursing license;
- Nurse Practitioner Certification from the ANCC or AANP;
- Board Certified through the AANP or ANCC;
- Current CPR certification;
- Compliance with recommended Healthcare Personnel Requirements for vaccinations and preventive testing;
- Home Health experience a plus;
- Effective communication skills 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.
