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Nurse Practitioner
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Nurse Practitioner
4 weeks ago
The RA Nurse Practitioner will conduct virtual visits to complete Clinical Risk Adjustment Assessments for Adult and Pediatric patients. This role does not require treatment, procedures, or medication prescribing.
Key Responsibilities:- Verify prior clinical diagnosis and access for worsening or resolution of assigned members.
- Access members for new or undiagnosed conditions.
- Perform medication reconciliation where necessary.
- Order labs to confirm diagnosis.
- Make recommendations to PCP for diagnostic tests.
- Provide updated clinical diagnosis lists.
- Document clinical evidence for severity of illness and disease burden.
- Provide ICD-10 coding for clinical diagnosis.
- Include Risk Adjustable codes (HCC) for patient's current health status.
- Ensure accurate and timely completion of Encounter documentation.
- Execute Health Plan Member referrals and concerns.
- Provide administrative notification of critical Health Plan Member issues.
- Interact with staff and members to optimize workflow efficiency.
- Follow SCCP policies and procedures.
- Comply with Performance Goals and Contract Deliverables.
- Participate in SCCP mandatory and CMS regulatory trainings.
- Attend staff meetings and maintain knowledge of content.
- Abide by SCCP information security policies and practices.
- Participate in information security management trainings.
- Develop a comprehensive understanding of SCCP information security policies.
- Recognize and report information security risks.
- Comply with SCCP user access, password, and data protection policies.
- Comply with SCCP internet use and personal workspace security policies.
- Abide by principles and laws related to confidentiality.
- Demonstrate respect for individual diversity.
- Family Nurse Practitioner in good standing, licensed to practice in Illinois.
- Experience in conducting Risk Assessments.
- Ability to conduct health assessments and keep members at ease.
- 10+ years of clinical experience.
- Ability to work with others and possess good problem-solving skills.
- Computer literacy in Word, Google Doc, and Excel.
- Able to multi-task, manage time, and set priorities.
- Able to remain coachable and teachable.
- Demonstrates cultural competence and sensitivity.
- High work ethic, self-motivation, and ability to work independently and on a team.
- Strong ability to write and verbally communicate in a clear, concise, and professional manner.
- Able to set and manage multiple priorities to meet deadlines with minimal supervision.
