Advanced Practice Nurse

2 weeks ago

Canton, Ohio, United States ComplexCare Solutions Full time
Position Overview

ComplexCare Solutions (CCS) is dedicated to providing essential in-home and virtual health assessments for health plans across the nation. Our mission focuses on engaging members to assess their health status, identify care gaps, recognize potential health risks, and explore care management opportunities, all aimed at enhancing clinical outcomes. Our visits allow Providers to dedicate a full hour to each member, enabling a thorough understanding of their unique needs and requirements to maintain their health at home and avoid hospitalization.

Key Responsibilities

  • Familiarity with CMS Regulations and NCQA HEDIS Guidelines;
  • Understanding of Evidence-based Clinical Practice Standards including those from the American Diabetes Association (ADA), American College of Cardiology (ACC), and American Heart Association (AHA); knowledge of ICD-9, ICD-10, and CPT-4 coding practices;
  • Conduct comprehensive and precise evaluations of the assigned member population, ensuring timely completion and submission of all necessary encounter documentation (either paper or electronic);
  • Document all relevant and active medical conditions in compliance with CMS/DHHS, Inovalon policy, and client specifications;
  • Support the physician-patient relationship through timely communication, documentation of assessment findings, recommendations, and necessary follow-up actions with primary care providers (PCP) and health plans;
  • Provide general recommendations to members to enhance their understanding of chronic conditions, including information on recommended testing;
  • Identify and address gaps in care, whether disease-specific or preventive;
  • Recognize urgent situations that require escalation and take appropriate actions as per Inovalon policies and professional judgment;
  • Perform, document, and communicate results of Point of Care (POC) Testing;
  • Maintain adherence to Inovalon's policies, procedures, and mission statement;
  • Uphold confidentiality and HIPAA requirements as outlined in Inovalon's Operating Policies and Procedures;
  • Fulfill responsibilities that contribute to the operational and financial success of the organization;
  • Ensure compliance with the separation of duties relevant to your job function;
  • Other duties as assigned.

Qualifications

  • Active, unencumbered nursing license;
  • Nurse Practitioner Certification from ANCC or AANP in Family, Adult, Gerontology, or Emergency Medicine;
  • Current CPR certification;
  • Compliance with recommended Healthcare Personnel Requirements for vaccinations and preventive testing prior to hire, including Hepatitis B, Influenza, MMR, Tdap, Varicella, and Tuberculosis;
  • Experience in Home Health is advantageous;
  • Ability to effectively communicate with elderly and chronically ill patients and their families;
  • Understanding of Medicare, Medicaid, and Health Plan benefit structures is beneficial;
  • Strong multitasking abilities;
  • Excellent customer service skills;
  • Bilingual or multilingual capabilities are a plus.

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