Nurse Practitioner Specialist

22 hours ago


Columbus, Ohio, United States ComplexCare Solutions Full time
Job Title: Nurse Practitioner

ComplexCare Solutions is seeking a skilled Nurse Practitioner to join our team. As a Nurse Practitioner, you will play a vital role in delivering high-quality care to our members.

Responsibilities:
  • Knowledge of CMS Regulations and NCQA HEDIS Guidelines;
  • Familiarity with ICD-10 and CPT-4 coding practices;
  • Complete comprehensive, accurate and thorough review of the assigned member population, including timely completion and submission of all required encounter documentation (paper or electronic);
  • 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, need for additional services, emergency services required if necessary and need for follow up and timelines for follow up to primary care provider (PCP) and health plan as required;
  • Make general recommendations to members intended to improve members' knowledge of their chronic condition(s), such as information concerning recommended testing;
  • Address and close 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 as determined by reasonable professional judgment and ethical professional practice standards; and
  • Perform, document and communicate results of Point of Care (POC) Testing.
Qualifications:
  • Active un-encumbered license to practice nursing;
  • Nurse Practitioner Certification from either the ANCC or AANP; in Family, Adult, Gerontology or Emergency Medicine.

We reserve the right to change this job description from time to time as business needs dictate and will provide notice of such.


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