Job Title:
Annual Wellness Visit (AWV) Registered Nurse
Department: Population Health
FLSA Status
: Non-exempt
About us
Physicians East a team of skilled healthcare professionals united to meet the challenge of delivering quality cost-efficient comprehensive healthcare to the people of Eastern North Carolina.
Location & commitments
Part Time role - Hybrid Work Model -
based at our Arlington location Hours are flexible. Option to work partly from home in HIPAA appropriate setting.
Supervision Received:
Reports to Population Health supervisor.
Supervision Exercised:
None.
Typical Physical Demands:
Requires full range of body motion manual and dexterity and eye-hand coordination. Requires normal visual acuity and hearing. Requires sitting for extended periods.
Typical Working Conditions:
Office environment or home office setting.
About the role
The Annual Wellness Visit (AWV) Registered Nurse is responsible for coordinating and conducting Medicare Annual Wellness Visits in accordance with CMS guidelines. The RN works collaboratively with primary care providers and the interdisciplinary care team to identify preventive care needs close quality gaps promote chronic disease management and improve patient outcomes while ensuring accurate documentation within the electronic health record (EHR)
Responsibilities
: (This list may not include all the duties assigned.)
Annual Wellness Visits
Conduct Medicare Initial Preventive Physical Exams (IPPE) Initial Annual Wellness Visits and Subsequent Annual Wellness Visits according to CMS requirements.
Obtain and document comprehensive patient histories including:
Medical and surgical history
Family history
Social history
Current medications and allergies
Perform and document:
Health Risk Assessment (HRA)
Functional status assessment
Fall risk screening
Depression screening (PHQ-2/PHQ-9 as appropriate)
Cognitive assessment
Safety assessment
Advance care planning discussions
Record vital signs and other required clinical measurements.
Develop and update each patients Personalized Prevention Plan.
Quality & Preventive Care
Identify and close preventive care gaps.
Review immunization status and recommend appropriate vaccines.
Ensure recommended screenings are ordered or scheduled including:
Mammograms
Colon cancer screening
Bone density testing
Lung cancer screening
Abdominal aortic aneurysm screening
Hepatitis C screening
Coordinate referrals for preventive services when appropriate.
Care Coordination
Collaborate with physicians nurse practitioners physician assistants care managers referral coordinators and ancillary departments.
Identify patients who may benefit from Chronic Care Management (CCM) or other care management programs.
Coordinate follow-up appointments for medical conditions identified during the wellness visit.
Communicate abnormal findings to the patients provider.
Documentation & Compliance
Complete all documentation accurately and timely within the EHR.
Ensure compliance with CMS Medicare payer and organizational documentation standards.
Assist with quality reporting initiatives including MIPS ACO HEDIS and other value-based care programs.
Support accurate coding by documenting required components of the Annual Wellness Visit.
Patient Education
Educate patients regarding:
Preventive health recommendations
Lifestyle modifications
Nutrition and exercise
Tobacco cessation
Fall prevention
Medication adherence
Advance directives
Population Health
Identify eligible Medicare beneficiaries for Annual Wellness Visits.
Participate in outreach initiatives to improve AWV completion rates.
Monitor quality dashboards and assist in achieving organizational quality goals.
Candidate requirements
Graduate of an accredited Registered Nursing program.
Current RN license in the applicable state.
BLS certification required.
Experience with value-based care initiatives.
Affirmative Action/EEO statement
Physicians East P.A. is an equal opportunity employer and will not discriminate against any applicant or employee on the basis of age race color ethnicity religion creed sex (including gender pregnancy sexual orientation and gender identity which includes status as a transgender individual) national origin or ancestry citizenship past current or prospective service in the uniformed services genetic information (including family medical history) physical or mental disability or other legally protected status. Reasonable accommodation will be made for persons with disabilities during the application process and/or at the time of employment. Requests for accommodation should be made to the Human Resources Department as early as possible in the application/employment process. Contact HR Office at
Disclaimer
Please note this job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of the employee for this job. Duties responsibilities and activities may change at any time with or without notice.
Required Experience:
IC
