In Home Assessment Nurse Practitioner

POSITION SUMMARY

The In-Home Assessment Nurse Practitioner ensures the company maintains high standards of patient outcomes and compliance with applicable regulatory requirements, by performing comprehensive in-home assessments for members by reviewing all their needs including: medical, social/psychological, financial, caregiver support and environmental safety. Assist in resolution of member complaints and/or grievances.

COMPLIANCE WITH REGULATIONS

Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal.

RESPONSIBILITIES

Conduct comprehensive IHAs that include, but are not limited to:

• Review of member history.
• Document treatment plan for each identified risk adjusted code to support the diagnoses. All documentation must be legible.
• Document recommendations for additional screening tests to identify and/or support suspected, but not proven, risk-adjusted diagnoses.
• Assess need for home adaptation equipment.
• Assess need for transportation to and from other health care providers.
• Identify responsible party (decision maker) for Member or advocates, or any active family support/assistance. Document support contact information, if available.
• Review and document Member medications, date(s) of prescription(s) and prescriber(s); note expired drugs.
• Document all Member past and present medical conditions by ICD-10 code; collaborate with CHG claims coders.
• Forward IHA record and superbill to CHG within three (3) Working Days of IHA.
• Collaborate and regularly communicate with CHG Chief Operating Officer as requested.
• Identify metrics and key performance indicators to be reported to CHG on a regular basis as mutually agreed upon by the parties.
• Cooperate with CHG Chief Operating Officer to resolve Member complaints and grievances.
• Notify CHG of broken appointments.
• Meet with CHG, at CHG's request, to review cases and discuss opportunities for operational improvements.
• Assist in resolution of member complaints and/or grievances.

EDUCATION

• Current, unencumbered NP license in California

EXPERIENCE/SKILLS

• Two years, post graduate hands-on clinical experience.
• Bilingual, English/Spanish or English/Vietnamese preferred.
• Experience with and sensitivity to cultural background and linguistic needs of membership.
• Familiarity and respect for special social needs of Medi-Cal and Medicare populations.
• Familiarity with Medi-Cal and Medicare program eligibility and community based organizations.
• Excellent communication and interpersonal skills.

PHYSICAL REQUIREMENTS

• Will be required to conduct home and on-site visits.
• Constant driving within San Diego County.
• Must be available to work evenings, weekends, and some holidays.
• Will be required attend meetings outside of facility or normal business hours.
• Valid driver's license, working/reliable vehicle, and automobile insurance.

The above statements describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

Community Health Group is an equal opportunity employer committed to fair and equitable treatment for all employees. We prohibit discrimination and harassment based on any protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, and training. Community Health Group makes hiring decisions based solely on qualifications, merit, and business needs at the time.