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Advanced Practice Nurse

2 months ago

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

ComplexCare Solutions (CCS) is dedicated to providing exceptional in-home and virtual health assessments for health plans across the nation. Our mission focuses on engaging members to evaluate their health status, identify care gaps, assess potential health risks, and explore care management opportunities, all aimed at enhancing clinical outcomes. Our practitioners have the unique opportunity to spend an entire hour with each member, allowing for a thorough understanding of their individual needs and the necessary steps to maintain their health at home.

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);
  • Conduct comprehensive reviews of assigned member populations, ensuring timely completion and submission of all required documentation;
  • Document all relevant medical conditions in compliance with CMS/DHHS, Inovalon policy, and client requirements;
  • Facilitate effective communication between physicians and patients, ensuring documentation of assessments, recommendations, and follow-up needs;
  • Provide general recommendations to enhance members' understanding of their chronic conditions, including information on necessary testing;
  • Identify and address gaps in care, whether disease-specific or preventive;
  • Recognize urgent situations requiring escalation and respond appropriately according to professional standards;
  • Perform and document results of Point of Care (POC) Testing;
  • Adhere to Inovalon's policies, procedures, and mission statement;
  • Maintain confidentiality and comply with HIPAA regulations at all times;
  • Fulfill additional responsibilities as needed to support the operational and financial success of the organization;
  • Uphold the separation of duties within your role;
  • 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 vaccination and testing requirements;
    • Hepatitis B
    • Influenza
    • MMR: Measles, Mumps, and Rubella
    • Pertussis, Tetanus, and Diphtheria (Tdap)
    • Varicella
    • Tuberculosis
  • Experience in home health is advantageous;
  • Ability to communicate effectively with elderly and chronically ill patients and their families;
  • Knowledge of Medicare, Medicaid, and Health Plan benefit structures is beneficial;
  • Strong multitasking abilities;
  • Excellent customer service skills;
  • Bilingual or multilingual skills are a plus.