The Medicare Wellness Nurse Specialist independently provides Annual Wellness Visits for ECU Physician patients. The selected candidate will perform advanced care planning, depression screening, health risk assessments, medical and social history, risk factors and health conditions management, preventive screening schedule, patient education, and referral management.
Also, the medicare wellness nurse will:
Perform chart analysis before each visit to ensure the patient will qualify for an Annual Medicare Wellness visit based on Centers for Medicare and Medicaid (CMS) guidelines.
Identify care gaps that are due to be closed and works with patients to get procedures scheduled for required preventive screenings as needed.
Collaborate with patients, caregivers, and providers to develop a comprehensive plan of care.
Participate in data collection/monitoring and formulation of process improvement plans. Maintains Care Gap closure data indicating the number of care gaps closed so that downstream revenue can be tracked.
Maintain clear and effective ongoing communication with providers. Methods of communication include documentation in the electronic health record, in basket messaging and oral communication to ensure continuity of care for patients.
Identify priorities and organizes work accordingly. Complete chart documentation for patient visits within 24 hours of the visit.
Demonstrate sound clinical judgment.
Follow evidence-based practices and standards of care for the Medicare Wellness Patient Population-based on Centers for Medicare and Medicaid guidelines.
Identify educational needs of patient/family and provides instruction and community resources /referrals to meet patient healthcare goals.
Utilize motivational interviewing to support patient self-management skills.
Apply adult learning principles to facilitate behavior change and patient empowerment. Provides coaching and disease management services to identified populations.
Demonstrate advanced nursing assessment and critical thinking to identify situations when a physician consultation is needed during a Medicare Wellness Visit to address acute medical needs.
Serve as an expert clinical leader within ambulatory clinics. Serve as a quality resource in the clinical practices.
Act as a resource for staff and providers in the identification and use of hierarchical condition categories (HCC) coding for the Medicare Wellness patients.
Monitor the use of HCC codes and updates patient charts at each visit.
Ensure proper billing codes are utilized for the Medicare Wellness visits for maximum reimbursement.
Review monthly patient volume and billing reports to ensure established thresholds are being met to ensure the success of the Medicare Wellness Program.
Work closely with ECU Physicians Clinical Finance to ensure that providers are notified of any change in billing as Medicare updates its billing policies.
Work closely with the NACO for Clinical IT and Quality to abstract charts, review reports on quality initiatives as Meaningful Use, Patient-Centered Medical Home (PCMH), Physician Quality Reporting System (PQRS), Healthcare Effectiveness Data and Information Set (HEDIS), and the Accountable Care Organization (ACO) Assists the NACO for Clinical IT and Quality to lead and direct quality projects across ECU Physicians.
Serve as clinical informatics resource for ECU Physicians leadership and clinical departments on quality initiatives Works closely with Nurse Managers to advise/direct clinical workflow to ensure that quality measures are being captured Works closely with Electronic Health Record Trainers to ensure that training programs fully incorporate the quality mandates Develop and maintain relationships and effective communication with all levels of ECU Physicians to facilitate problem identification and resolution.
CLINICALSUPPORTPOSITION – NOTSUBJECT TO STATEHUMANRESOURCESACT.
The ECU Brody School of Medicine is affiliated with Vidant Medical Center. Vidant Medical Center is the flagship hospital for Vidant Health and serves as the teaching hospital for the Brody School of Medicine at East Carolina University.
Special Instructions To Application:
Please ensure your full range of knowledge, skills, abilities, experience and education are listed on your application. Do not write ‘see resume’ on your application when completing the job duties section.
If you answer the questions at the end of the application, please ensure your application reflects the knowledge, skills, abilities and experiences to support your answers (see job duties section of previous employment).
Failure to answer the questions at the end of the application will not preclude your application from being considered but may result in your application not receiving full consideration of your knowledge, skills, and abilities.
Applicants must be currently authorized to work in the United States on a full time basis.
Graduation from state-accredited school of registered nursing and two years of nursing experience, with at least one year in the assigned specialty area. Must have a current license to practice as a Registered Nurse in North Carolina by the North Carolina Board of Nursing. All degrees must be received from appropriately accredited institutions.
Full time or Part time: Full Time
Position Location (city): Greenville
Position Number: 002568
Organizational Unit Overview:
ECU Physicians is the multispecialty group practice of the Brody School of Medicine. With more than 430 providers and over 700,000 patient visits per year, this complex organization faces increasing challenges for its robust clinical informatics system. The Office of Clinical Informatics was formed to provide oversight of all clinical applications and clinical quality initiatives throughout ECU Physicians. Quality responsibilities are carried out directly or through collaboration with the Quality Committee, ECUP leadership, faculty and staff in each clinical department. Quality initiatives include, but are not limited to: Meaningful Use, Physician Quality Reporting System (PQRS), Accountable Care Organization (ACO), Merit Based Incentive Programs (MIPS), Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assessment (NCQA) recognition programs, Heart Health Now, and the MyChart patient portal. In addition clinical applications include the use of Tele health/Telemedicine.
To be a national model for student success, public service and regional transformation, East Carolina University uses innovative learning strategies and delivery methods to maximize access; prepares students with the knowledge, skills and values to succeed in a global, multicultural society; develops tomorrow's leaders to serve and inspire positive change; discovers new knowledge and innovations to support a thriving future for eastern North Carolina and beyond; transforms health care, promotes wellness, and reduces health disparities; and improves qualify of life through cultural enrichment, academics, the arts, and athletics. We accomplish our mission through education, research, creative activities, and service while being good stewards of the resources entrusted to us. East Carolina University delivers on the promise of opportunity. We open doors. We improve lives. We transform the present, and we discover the future. In these ways and more, we serve our community, our state, our nation and our world as together we reach toward our greatest potential. Tomorrow starts here.