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Advanced Practice Nurse
2 months ago
ComplexCare Solutions (CCS) is dedicated to providing exceptional in-home and virtual assessments for health plans across the nation. Our focus is on engaging members to evaluate their health status, identify care gaps, assess potential health risks, and explore care management opportunities, all aimed at improving clinical outcomes. Our visits allow Providers to spend a full hour with members, enabling a thorough understanding of their unique needs and requirements to maintain their health at home and prevent hospitalizations.
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 and precise evaluations of the assigned member population, ensuring timely completion and submission of all necessary encounter documentation;
- Document all relevant and active medical conditions in compliance with CMS/DHHS, Inovalon policy, and client specifications;
- Support the physician-patient relationship by ensuring effective communication and documentation of assessment findings, 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 take appropriate actions as per Inovalon policies and professional standards;
- Perform and document results of Point of Care (POC) Testing;
- Maintain adherence to Inovalon's policies, procedures, and mission statement;
- Uphold confidentiality and HIPAA requirements in all aspects of data handling and service delivery;
- Fulfill responsibilities that contribute to the operational and financial success of the organization;
- Ensure separation of duties in applicable processes and procedures within your role;
- Other duties as assigned.
- 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 Requirements for vaccinations and preventive testing;
- Hepatitis B
- Influenza
- MMR: Measles, Mumps, and Rubella
- Pertussis, Tetanus, and Diphtheria (Tdap)
- Varicella
- Tuberculosis
- Experience in Home Health is advantageous;
- Ability to effectively communicate 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.
