Bilingual Risk Adjustment Nurse Practitioner

7 days ago


IL United States Southland Care Coordination Partners Full time
Risk Adjustment Nurse Practitioner Job Description

Southland Care Coordination Partners is seeking a skilled Risk Adjustment Nurse Practitioner to join our team. As a key member of our Medical Management Services department, you will play a critical role in improving prospective risk adjustment results and closing care gaps for our health plan members.

Key Responsibilities:
  • Perform comprehensive health risk assessments for assigned members to identify potential health risks and opportunities for improvement.
  • Develop and maintain accurate and up-to-date clinical profiles for members, including relevant medical history, diagnoses, and treatment plans.
  • Provide detailed documentation and notes to support clinical profiles, ensuring compliance with regulatory requirements and performance goals.
  • Apply appropriate clinical coding to updated clinical profiles, ensuring accurate and timely data submission.
  • Collaborate with direct report and other stakeholders to ensure timely management notification of critical member issues or concerns.
  • Participate in mandatory and regulatory trainings, including SCCP and CMS requirements.
  • Attend staff meetings and contribute to team discussions.
Requirements:
  • Certified Nurse Practitioner (NP) with significant clinical experience.
  • Active State of Illinois Nurse Practitioner license.
  • Experience in conducting risk adjustments or health risk assessments.
  • Proficiency in diagnosis, billing, and quality measures.
  • Understanding of Medicare and Medicaid health plans.
  • Experience using an EMR to input assessment data.
  • Able to work a minimum of twenty (20) hours per week.
Preferred Qualifications:
  • Good communication skills.
  • Ability to interact with healthcare professionals in a professional manner.
  • Experienced diagnostician and critical thinker.
  • Experienced with ICD-10 diagnostic codes and HCC codes.
  • Excellent organizational, written, and verbal communication, and interpersonal skills.
Benefits:
  • Competitive salary range: $110,000 - $124,000 per year.
  • 401(k) plan.
  • Dental insurance.
  • Health insurance.
  • Life insurance.
  • Paid time off.
  • Retirement plan.
Work Environment:
  • On-site/remote work arrangement.
Education and Experience:
  • 1 year of experience in health risk assessment or risk adjustment.
  • 1 year of experience using an EMR.
  • Preferred: 1 year of experience in a related field.
Language:
  • Spanish (preferred).
License/Certification:
  • Certified Nurse Practitioner (required).
  • Impact (preferred).

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