Medicare Wellness Nurse Practitioner
Posted on Jun 17, 2019 by Vera Whole Health
- Provides evidence-based medical care while meeting the needs of the patient and respecting their diverse backgrounds.
- Assesses the needs of the population they serve and works with team members to develop plan of care to meet the needs of this patient population
- Knowledge and understanding of HCC, ICD 10, and RAF coding measures as they integrate with a Wellness Visit in the Medicare population. Ability to provide these assessments while bonding with the patient to provide assessment of the bio, psycho, social needs.
- Ability and knowledge to review claims data and previous records to assure accurate coding and documentation of chronic disease is present for the member
- Assures comprehensive care in alignment with the Vera Medical Home model including collection of comprehensive health history, performing appropriate physical examinations, performing, ordering and analyzing diagnostic tests. With the care team develops and implements a biopsychosocial plan of care, including appropriate disease management, case management, wellness and prevention coaching.
- Ability to work with a Medicare population and manage to quality metrics for this population including HCC coding
- Collaborates with Quality Improvement team to assure appropriate care is documented
- Manages 5-10 patients per day by providing Wellness exams and some acute care medical services to patients.
- Serve as part of the after-hours on-call team in rotation with other Providers in the region.
- Acts as a clinical leader of a care team including actively supporting change management
- Collaborates in developing team priorities and patient goals and care plans through team meetings, huddles and just in time communication
- In collaboration with clinic manager, participates in, process improvement, quality assurance, and ongoing development of the team-based approach.
- Promotes health and wellness for patients through the coordination of health coaching, health risk assessment and other health promotion activities. Provides tailored counseling and effective motivational interviewing through establishing appropriate goals and action plans.
- Conform to the requirements and expectations of the client contract.
- Participates in non-clinical organizational activities and committees (e.g. weekly provider meetings, clinical advisory committee, quality improvement committee, etc.).
- Achieves target objectives to meet company requirements by improving the health status of the eligible population and meets established benchmarks for clinical outcomes, engagement & patient satisfaction.
Additional Qualifications Preferred:
- 2 years direct patient care with case management emphasizing wellness and health promotion and population health management
- 1-2 years direct patient care in the Medicare Wellness space
- 2 years computer skills, including EMR experience required
- Experience in coding including the Medicare Advantage and HCC coding
- Team based Care experience
- Documentation of Hep B vaccination or proof of immunity (titer).
- Documentation of proof of a negative TB test in the last 90 days before start-date.
- Must show proof of current CPR certification.
- Minimum required Masters of Science in Nursing (MSN)
- Family Nurse Practitioner/Adult Nurse Practitioner or Gerontologic Nurse Practitioner with national board certification.
- 3-5 years' experience with primary care and case management in a collaborative shared-patient team.
- Current RN and ARNP licensure (valid, in good standing).
- Current and valid DEA number. JWMP