002568 - Medicare Wellness Nurse

Job Category

Staff - Medical

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.

Primary Purpose of Position/Job Duties:

Primary Purpose of the Position

The primary purpose of the Nurse Specialist is to serve as a provider of Medicare Annual Wellness Visits. Annual Wellness visits are comprised of Advanced Care Planning, Depression Screening, Health Risk Assessment, Medical and Social History, Risk factors and health conditions management, preventive screening schedule, patient education and referral management. The Nurse Specialist performing these duties will be able to assist the provider with billing for services provided thus will need to be knowledgeable of billing practices.

In addition, this position will assist with other quality projects for ECU Physicians such as Meaningful Use, Healthcare Effectiveness Data and Information Set, Merit Based Incentive Programs, and Physicians Quality Reporting System by closing care gaps. This will be accomplished by the review of records, patient education and ensuring that referrals for preventive health services are scheduled and documented to close existing and potential care gaps.

The nurse specialist will communicate and educate staff and providers about the use of hierarchical condition categories (HCC) coding for the Medicare Wellness patients which will help improve ECU Physician’s billing, reimbursement and ACO acuity ratings for this patient population. The nurse specialist serves as a consultant for the Medicare Wellness Program and assist staff and providers manage this patient population. The position will report to the Nurse Administrator of Clinical IT and Quality who will provide oversight related to the quality job duties.

Job Duties

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.

CLINICAL SUPPORT POSITION – NOT SUBJECT TO STATE HUMAN RESOURCES ACT.

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.

Minimum Education/Experience

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.

License or Certification required by statute or r

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.

Preferred Experience, Skills, Training/Education

Registered Nurse with at least 5 years of nursing experience

Experience with Medicare Wellness or Health Coaching

Demonstrate sound clinical judgment.

License or Certification required by the Department

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.

Special Instructions to Applicant