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Advanced Practice Nurse
2 months ago
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 assess their health status, identify care gaps, evaluate potential health risks, and explore care management opportunities, all aimed at enhancing clinical outcomes. Our approach allows Providers to spend an entire hour with members, ensuring a thorough understanding of their unique needs to support their health and well-being at home.
Key Responsibilities
- Understand and apply CMS Regulations and NCQA HEDIS Guidelines;
- Familiarity with 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 necessary documentation;
- Document all relevant medical conditions in compliance with CMS/DHHS, Inovalon policies, and client specifications;
- Facilitate effective communication between physicians and patients, ensuring proper documentation of assessments, recommendations, and follow-up needs;
- Provide general guidance to members to enhance their understanding of chronic conditions and necessary testing;
- Identify and address gaps in care, whether disease-specific or preventive;
- Recognize urgent situations requiring escalation and respond appropriately based on professional judgment and ethical standards;
- Perform and document results of Point of Care (POC) Testing;
- Maintain adherence to Inovalon's policies, procedures, and mission;
- Uphold confidentiality and HIPAA regulations in all aspects of data handling and service delivery;
- Fulfill additional responsibilities as assigned to support the operational and financial success of the organization;
- Other duties as required.
- Active, unrestricted 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;
- Experience in Home Health is advantageous;
- Ability to communicate effectively 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.
