Risk Adjustment Nurse Practitioner

Job Description:The RA Nurse Practitioner (NP) will conduct virtual visits for the sole purpose of completing a Clinical Risk Adjustment Assessment for Adult and Pediatric patients. This role does not require any treatment, performance of procedures or prescribing of medication.ROLES AND RESPONSIBILITIES:Verify prior clinical diagnosis and access for any worsening or resolution of said diagnosis, for assigned members.Access member for any new or undiagnosed conditions.Perform medication reconciliation where necessary.Order labs necessary to confirm diagnosis.Make recommendations to PCP if diagnostic tests are required to confirm diagnosis.Provide an updated clinical diagnosis list.Provide documentation to support updated clinical diagnosis, to include clinical evidence for severity of illness with appropriate capture of true disease burden and quality using official Risk Adjustment and relevant official documentation/coding guidelines.Provide ICD-10 coding to the highest level of specificity, for clinical diagnosis.Include all Risk Adjustable code (HCC) that apply to patientxe2x80x99s current health status.Ensure accurate and same day completion of all Encounter documentation that does not require lab results.Properly executes Health Plan Member referrals/concerns/grievances when applicable.Provide timely administrative notification of any critical Health Plan Member issues/concerns.Interact with staff and members to optimize workflow efficiency.QUALIFICATIONS AND EDUCATION REQUIREMENTS:Family Nurse Practitioner in good standing, licensed to Practice in the state of Illinois.Experience in conducting Risk Assessments.Ability to conduct health assessments by asking probing questions while keeping the member at ease.Ten (10) years or more clinical experience.Ability to work with others.Good problem-solving skills.PREFERRED SKILLS:Computer Literate xe2x80x93 Word, Google Doc, and Excel.Able to multi-task, manage time, and set priorities.Able to remain coachable and teachable at all times.Demonstrates cultural competence and sensitivity in working with diverse populations.High work ethic, self-motivation, and ability to work independently as well as on a team.Strong ability to write and verbally communicate in a clear, concise, and professional manner.Able to set and manage multiple priorities to meet deadlines with minimal supervision.(Bilingual Preferred)