0105 Patient Continuum of Care
Schedule: Monday-Friday 8:00-4:30
About the Position
Under the direction of the Director and Annual Wellness Supervisor, the Annual Wellness Specialist (AWS) provides direct and indirect professional nursing care to the Medicare patient population through conducting Medicare Annual Wellness interviews and capture of Hierarchical Condition Categories to ensure quality care and documentation for our Medicare population. The AWS collaborates with the Primary Care Providers for continuum of care across the Reid Health system
Overview of Responsibilities
· Completes AWI to ensure all billing requirements and quality indicators are met. · Quality indicators set by the quality department must be documented in correct location within the EHR to ensure capture of measures. · Code AWI and quality metrics utilizing Category II coding methodology. · Scribes “Welcome to Medicare” visits for Medicare population with providers.
· Meets monthly productivity standards set by Director and Annual Wellness Supervisor.
· Open communication with patients, staff in RHPA Primary Care, providers, Annual Wellness Coordinator, and Annual Wellness Supervisor.
· Works with Annual Wellness Supervisor when not meeting weekly, monthly, quarterly, and YTD targets.
· Takes notes and engaged in meetings. Asks questions regarding any process changes prior to leaving meeting or shortly after meeting
· Assists in other monitoring activities, special department projects or other needs as determined by the Annual Wellness Supervisor.
· Provide ongoing AWS team learning opportunities through sharing of professional knowledge and journal articles.
· AWS will support and implement quality measures as identified by ACO and Reid Health Alliance
· Completes assignments given by Annual Wellness Supervisor or Director in a timely manner.
This list of duties and responsibilities is not intended to be all-inclusive and can be expanded to include other duties or responsibilities that management deems necessary.
Education & Experience
Education Required: LPN or RN, ASN
Education Preferred: Advanced degrees in Nursing
Experience Required: 2 or more years of experience working in an acute care setting or ambulatory office setting
Experience Preferred: Previous experience with Epic or as an Annual Wellness Specialist
Licensure & Certification
