Job Title: Risk Adjustment Nurse Practitioner (Walk-in Clinic)

Job Category: Clinical

Department/Group: Medical Management Services / Risk Adjustment

Direct Report: Manager of Risk Adjustment

Location: On-site/Remote

Job Description: The Nurse Practitioner is responsible for performing Member health assessments to help improve prospective risk adjustment results and close care gaps.

Role and Responsibilities:

  • Perform Walk-in/Telephonic/Telehealth Health Risk Assessments for assigned Health Plan Members.
  • Complete an accurate and substantiated clinical profile of assessed members.
  • Provide comprehensive and detailed documentation and notes that support updated clinical profile.
  • Apply appropriate clinical coding to updated clinical profiles.
  • Compliant with Performance Goals / Contract Deliverables of Health Plan.
  • Timely management notification of any critical member issue/concern.
  • Participates in all SCCP mandatory and CMS regulatory trainings.
  • Attends all staff meetings – in person or telephonic.
  • Other duties as assigned by Direct Report.

Qualifications and Education Requirements:

  • A certified Nurse Practitioner (NP) with considerable clinical experience.
  • Active State of Illinois Nurse Practitioner license.
  • Experienced in conducting Risk Adjustments or Health Risk Assessments.
  • Proficient with Diagnosis, Billing, and Quality Measures.
  • Understanding of Medicare and Medicaid Health Plans.
  • Experienced in using an EMR to input assessment data.
  • Able to work a minimum of twenty (20) hours per week.

Preferred Skills:

  • Good communication skills.
  • Ability to interact with health care professionals in a professional manner.
  • Experienced diagnostician and critical thinking
  • Experienced with ICD-10 diagnostic codes and HCC codes
  • Excellent organizational, written, and verbal communication, and interpersonal skills.
  • Medical Specialty
  • Primary Care
  • Physical Setting
  • Telehealth
  • Clinic

Part-time Call Center Representatives and Care Navigators

Hours 2 days per week 4:30 pm – 7:30 pm and 2 Saturdays per month 10 am – 2 pm. Must be vaccinated!

Job Description: The Call Center Representative is the heart of Call Center. This individual is the front line and first contact with Health Plan members. They apply excellent customer service skills in the day-to-day handling of both Inbound and Outbound Outreach calls.

ROLE AND RESPONSIBILITIES

  • Accurate documentation of every Outreach (Inbound and Outbound).
  • Complete Daily Productivity Report.
  • Proper execution of member referral/concerns/grievances when applicable.
  • Document timely member observations requiring administrative notification of any critical member issues/concerns.
  • Follows all Policies and Procedures of SCCP.
  • Compliant with Performance Goals / Contract Deliverables.
  • Participates in all SCCP mandatory and CMS regulatory training.
  • Attends all staff meetings – in person or telephonic (if unable to attend, responsible for knowledge of content).
  • Abide by principles and laws related to confidentiality.
  • Demonstrate respect for individual diversity (culture, ethnicity, gender, race, religion, age, economic status).
  • Interact with staff and members to optimize workflow efficiency.
  • Other duties as assigned by Direct Report.

QUALIFICATIONS AND EDUCATION REQUIREMENTS

  • High School Diploma or Equivalent Required.
  • Minimum of 1 year of Call Center Representative Experience Preferred.
  • Minimum of 1 year in a Customer Service role Preferred.

PREFERRED SKILLS

  • Excellent verbal communication skills.
  • Ability to interact with health care professionals in a professional manner.
  • Computer Literate – Word, Google Doc and Excel.
  • Able to multi-task, manage time and set priorities.
  • Able to remain coachable and teachable at all times.

Other Job Opportunities: