Nurse Practitioner

3 days ago

Peachtree City, Georgia, United States ComplexCare Solutions Full time
About the Role

We are seeking a skilled Nurse Practitioner to join our team at ComplexCare Solutions. As a key member of our healthcare team, you will be responsible for delivering high-quality, patient-centered care to individuals in their homes.

Responsibilities
  • Stay up-to-date with CMS Regulations and NCQA HEDIS Guidelines, and apply this knowledge to ensure accurate and thorough assessments of assigned member populations.
  • Utilize evidence-based clinical practice standards, including those from the American Diabetes Association, American College of Cardiology, and American Heart Association, to inform your care decisions.
  • Complete comprehensive reviews of assigned member populations, including timely completion and submission of all required encounter documentation.
  • Ensure that all pertinent and active medical conditions are documented in the medical record in a manner compliant with CMS/DHHS, Inovalon policy, and client requirements.
  • Support the physician/patient relationship and ensure timely and adequate communication, documentation of assessment findings, recommendations, and need for follow-up care.
  • Make general recommendations to members intended to improve their knowledge of their chronic condition(s), such as information concerning recommended testing.
  • Address and close identified gaps in care, including disease-specific or preventive care.
  • Recognize emergent or urgent situations requiring escalation and take appropriate action as specified in Inovalon policies, and as determined by reasonable professional judgment and ethical professional practice standards.
  • Perform, document, and communicate results of Point of Care (POC) Testing.
  • Maintain compliance with Inovalon's policies, procedures, and mission statement, and adhere to all confidentiality and HIPAA requirements.
Qualifications
  • Active, un-encumbered license to practice nursing.
  • Nurse Practitioner Certification from either the ANCC or AANP, in Family, Adult, Gerontology, or Emergency Medicine.
  • Board Certified through the AANP or ANCC.
  • Maintains current CPR certification.
  • Compliance, prior to hire, with recommended Healthcare Personnel Requirements for vaccinations and preventive testing.
  • Home Health experience a plus.
  • Ability to effectively communicate 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.
  • Bi-lingual or multi-lingual a plus.

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