OTHER

FEED

UNKNOWN

Ability to practice autonomously in a remote clinical environment, including independently conducting patient assessments, formulating evidence-based treatment plans, managing complex chronic conditions, and making soundclinical decisions without direct on-site supervision. Pay Range: $2,400.00 - $10,000.00 per month (Potential income) Earnings will vary based on completed assessments, state of residence, and business needs as there is no guarantee of visits or minimum income.

YEAR

Overview:
Nurse Practitioner Per DiemThis position covers all zip codes in: Santa Cruz County,  CA ComplexCare Solutions (CCS) specializes in helping those in need by delivering high-value home and virtual assessments for health plans nationwide. We pride ourselves on our member engagement aimed towards evaluating current health status, gaps in care, potential health risks and care management opportunities with a focus on driving better clinical outcomes. CCS, on behalf of SME Medical Delaware, P.A., is calling on Advanced Practice Providers that are passionate about helping their local communities. We care dearly about those whom we serve, and we need your help to make a difference in the lives of our members. Providers have the opportunity to spend a full hour with these members, which allows them to capture a comprehensive picture of that individual’s personal needs and what is required to keep them in the home and out of the hospital. <div class="x_x_elementToProof">Compensation:<ul><li style="margin:0in">Pay Range: $2,400.00 - $10,000.00 per month (Potential income) Earnings will vary based on completed assessments, state of residence, and business needs as there is no guarantee of visits or minimum income</li><li style="margin:0in">In-home visit rate: $120 - $140 depending on state of residence</li><li style="margin:0in">If available, our telehealth rate is $85 per completed assessment</li></ul></div>Benefit:This position is eligible to participate in a company 401K plan providing the opportunity to save for retirement through employee contributions. New hires will be automatically enrolled in the company 401(k) plan at a 3% contribution rate with the option to opt out.

Responsibilities:
<ul><li>Knowledge of CMS Regulations and NCQA HEDIS Guidelines</li><li>Knowledge of Evidence-based Clinical Practice Standards: American Diabetes Association (ADA), American College of Cardiology (ACC), American Heart Association (AHA), Familiarity with ICD-10 and CPT-4 coding practices</li><li>Complete comprehensive, accurate and thorough review of the assigned member population, including timely completion and submission of all required encounter documentation (paper or electronic)</li><li>Ensure that all pertinent and active medical conditions are documented in the medical record in a manner compliant with CMS/DHHS, Company policy, and client requirements</li><li>Support the physician/patient relationship and ensure timely and adequate communication, documentation of assessment findings, recommendations, need for additional services, emergency services required if necessary and need for follow up and timelines for follow up to primary care provider (PCP) and health plan as required</li><li>Make general recommendations to members intended to improve members' knowledge of their chronic condition(s), such as information concerning recommended testing</li><li>Address and close identified gaps in care (disease-specific or preventive)</li><li>Recognize emergent or urgent situations requiring escalation and take appropriate action as specified in company policies, and as determined by reasonable professional judgment and ethical professional practice standards; and</li><li>Perform, document and communicate results of Point of Care (POC) Testing</li><li>Maintain compliance with Company policies, procedures and mission statement</li><li>Adhere to all confidentiality and HIPAA requirements as outlined within the Company’s Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position</li><li>Fulfill those responsibilities and/or duties that may be reasonably provided for the purpose of achieving operational and financial success of the Company</li><li>Uphold responsibilities relative to the separation of duties for applicable processes and procedures within your job function</li><li>On a monthly basis, be available for a minimum of 25 slots of availability per month (approximately 37 hours)</li><li>We reserve the right to change this job description from time to time as business needs dictate and will provide notice of such</li><li>Other duties as assigned</li></ul>

Qualifications:
<ul style="margin-top:0in"><li>Active un-encumbered license to practice nursing</li><li>ANCC or AANP board certification as a Nurse Practitioner or Clinical Nurse Specialist in Family, Adult, Gerontology or Emergency Medicine. </li><li>Maintains current CPR certification</li><li>Compliance, prior to hire, with recommended Healthcare Personnel Requirements for vaccinations and preventive testing:</li><li><ul style="margin-top:0in"><li>Hepatitis B</li><li>Influenza</li><li>MMR: Measles, Mumps and Rubella</li><li>Pertussis, Tetanus and diphtheria and acellular pertussis (Tdap)</li><li>Varicella</li><li>Tuberculosis</li></ul></li><li>Home Health exp a plus </li><li>Must be able to effectively communicate with elderly and chronically ill patients and families</li><li>Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial</li><li>Ability to multitask</li><li>Excellent customer service skills</li><li>Bi-lingual or multi-lingual a plus</li><li>Ability to practice autonomously in a remote clinical environment, including independently conducting patient assessments, formulating evidence-based treatment plans, managing complex chronic conditions, and making soundclinical decisions without direct on-site supervision</li><li>Proficient with computer platforms, electronic health records (EHRs), secure messaging systems, and cloud-based documentation tools</li></ul>This company utilizes E-Verify. ComplexCare Solutions (CCS) is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status. By embracing diversity, equity and inclusion we enhance our work environment and drive business success. ComplexCare Solutions (CCS) strives to reflect the diversity of the communities where we operate and of our clients and everyone whom we serve. We endeavor to create a culture of inclusion in which our associates feel empowered to bring their full, authentic selves to work and pursue their professional goals in an equitable setting. We understand that by fostering this type of culture, and welcoming different perspectives, we generate innovation and growth.

ComplexCare Solutions

Nurse Practitioner (Per Diem)

American Nurses Credentialing Center (ANCC)

CPR Certification

Cardiology

Centers for Medicare and Medicaid Services (CMS)

Certified Coding Specialist (CCS)

Clinical Nursing

Clinical Outcomes

Clinical Practices/Protocols

Cloud Computing

Communication Skills

Computer Skills

Computer Systems

Content Management Systems (CMS)

Corporate Policies

Current Procedural Terminology (CPT)

Customer Support/Service

Department of Health and Human Services

Diabetes

Disease

Diversity

Documentation

Emergency Medicine

Emergency Services

Equal Employment Opportunity (EEO)

HIPAA (Health Insurance Portability and Accountability Act)

Health Plan

Healthcare

Healthcare Effectiveness Data and Information Set (HEDIS)

Hepatitis B

Home Care

Hospital

ICD-10

Maintain Compliance

Medicaid

Medical Conditions

Medical Record System

Medical Records

Medicare

Messaging Technology

Multilingual

Multitasking

National Committee for Quality Assurance (NCQA)

Nurse Practitioner

Nursing Credentials

Operations Processes

Patient Assessment

Primary Care

Regulations

Risk Management

Staff Requirements

Telehealth

Time Management

Treatment Plan

[AW]-iCims

Our practices include Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, Retinal Consultants of Arizona, M&M Eye Institute, Abrams Eye Institute, Southwest Eye Institute, Aiello Eye Institute, Moretsky Cassidy Vision Correction, Wellish Vision Institute, West Texas Eye Associates and Vantage Eye Center. Company Intro: At American Vision Partners (AVP), we partner with the most respected ophthalmology practices in the country and integrate best-in-class management systems, operational infrastructure, and advanced technology to provide the highest quality patient care possible.

Company Intro:
At American Vision Partners (AVP), we partner with the most respected ophthalmology practices in the country and integrate best-in-class management systems, operational infrastructure, and advanced technology to provide the highest quality patient care possible. Our practices include Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, Retinal Consultants of Arizona, M&M Eye Institute, Abrams Eye Institute, Southwest Eye Institute, Aiello Eye Institute, Moretsky Cassidy Vision Correction, Wellish Vision Institute, West Texas Eye Associates and Vantage Eye Center. We are focused on building the nation’s largest and most comprehensive eye care practices and currently operate more than 100 eye care centers in Arizona, New Mexico, Nevada, California and Texas – including 25 ambulatory surgical centers. At AVP we value teamwork, providing exceptional experiences, continuous improvement, financial strength, and hard work. We are committed to providing best-in-class patient care, pioneering research and technology, and most importantly, rewarding and recognizing our employees!

Overview:
This position verifies insurance coverage, benefits and obtains prior authorization for services. 

Responsibilities:
MAIN:<ol><li style="font-size:12pt">Contacts insurance plans to determine eligibility and obtain coverage and benefit information.</li><li style="font-size:12pt">Obtains prior authorization for services.</li><li style="font-size:12pt">Processes requests for prior authorization for surgery and/or procedure injections</li><li style="font-size:12pt">Identifies and resolves problems with participant eligibility/insurance coverage</li><li style="font-size:12pt">Accurately calculates patient responsibility amounts based on benefit information and payer allowable.</li><li style="font-size:12pt">Documents findings thoroughly and accurately.</li><li style="font-size:12pt">Prioritizes work to maximize turn-around time.</li><li style="font-size:12pt">Meets or exceeds productivity standards in the completion of daily assignments and accurate production.</li><li style="font-size:12pt">Maintain an error rate in accordance with departmental policy.</li><li style="font-size:12pt">Makes changes to demographic information as necessary in order to produce a clean patient statement.</li><li style="font-size:12pt">Answer and respond to external and internal phone calls in a timely manner.</li><li style="font-size:12pt">Check and respond to emails in a timely and professional manner.</li><li style="font-size:12pt">Performs all other assigned duties.</li></ol> GENERAL DUTIES:<ol start="13"><li style="font-size:12pt">Conducts self in accordance with the company’s standard values and policies.</li><li style="font-size:12pt">Participates in a variety of educational programs, corporate and professional, to maintain current skill and competency levels.</li></ol> The Essential Job Functions and Duties and Responsibilities listed above are not exhaustive.  The job functions and duties of this job may vary depending upon the specific nature and needs of the department, including size, location and services offered.  At some locations, employees may not perform all of the job functions or duties listed above.  At other locations, employees may perform some or all of the job functions or duties listed above and, in addition, may be required to perform other job functions or duties as directed. In addition, given the nature of its business, MMRG retains the right to modify the essential job functions and duties of this position at any time. METHOD AND FREQUENCY OF SUPERVISION: <ul><li style="font-size:12pt">Monthly meetings with supervisor. Informal supervision with employee through an open door policy.  Employee is expected to ask questions when needed. </li></ul> 

Qualifications:
Education: <ul><li style="font-size:12pt">High School diploma or equivalent </li></ul> Prior Experience: <ul><li style="font-size:12pt">Minimum of 1-2 years of insurance verification, referrals, prior authorization, or eligibility experience required experience preferred.</li></ul> Skills and Proficiencies: <ul><li style="font-size:12pt">Active knowledge of CMS guidelines contracted insurance guidelines and coding policies.</li><li style="font-size:12pt">Demonstrated computer literacy</li><li style="font-size:12pt">Well-organized with attention to detail</li><li style="font-size:12pt">Ability to read and understand oral and written instructions</li><li style="font-size:12pt">Excellent math skills</li><li style="font-size:12pt">Critical thinking skills are strongly preferred</li><li style="font-size:12pt">Ability to establish and maintain effective working relationship with team members, clinic staff, payers and patients.</li><li style="font-size:12pt">Professional customer service skills.</li><li style="font-size:12pt">Have a desire and dedication to work with self-discipline.</li><li style="font-size:12pt">Maintains the strictest confidentiality: adheres to all HIPAA guidelines and regulations.</li></ul> Physical Abilities: <ul><li style="font-size:12pt">Ability to sit for long periods. Work requires walking, bending, standing, sitting, and reaching</li></ul> 

Benefits & Perks:
Your health, happiness and your future matters! At Vantage Eye Center, we offer everything from medical and dental insurance, significant eye care discounts, child care assistance, pet insurance, continuing education funds, 401(k), paid holidays, PTO, Sick Time, opportunity for growth, and much more!

American Vision Partners

Authorization Specialist

Continuous Improvement

Demographics

Detail Oriented

Identify Issues

Injections

Insurance

Mathematics

Ophthalmology

Organizational Skills

Patient Care

Problem Solving Skills

System Operations

Team Player

Technical Research

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Nurse Practitioner (Per Diem)ComplexCare Solutions

Authorization SpecialistAmerican Vision Partners

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