Medicare Annual Wellness RN Registered Nurse Remote

Banner Health Remote
medicare rn registered nurse nurse remote health nursing education primary care management communication rn clinic
March 18, 2023
Banner Health
Greeley, Colorado
**Primary City/State:**

Greeley, Colorado

**Department Name:**

AZ Pop Health-Clinic

**Work Shift:**


**Job Category:**


**Primary Location Salary Range:**

$28.89/hr - $48.16/hr, based on education & experience

In accordance with State Pay Transparency Rules.

Nurses excel at Banner Health. With some of the best training in health care, we empower nurses to build long, successful careers. We care about you, your nursing career today and your future. Apply today.

This position requires expertise in the nursing process, using critical thinking skills to plan and coordinate care. Responsible and accountable for patient care for designated patient populations. Nursing experience in primary care, community nursing, critical care (ICU/ED) or utilization/prior authorization review would be helpful but not required. Knowledge/Experience with Risk Adjustment and Quality Measures (Stars, HEDIS) very helpful.

**Schedule:** **The hours to begin will be Monday-Friday, 8 hour shifts. We are flexible on start times e.g. 7am-3:30, 8am-4:30, etc.**

Location: This is a remote position. The position will support Northern Colorado clinics with two to three clinics assigned to each nurse depending on work volume.

**Candidate must live in one of the 6 states Banner is in: AZ, CA, CO, NE, NV or WY.**

Day to Day: This role is critical in improving care coordination, increasing utilization of preventative services and promoting early interventions for chronic disease management. The RN works in collaboration with the primary care provider and all members of the health care team. Responsibilities include identification of Medicare patients appropriate for Annual Wellness Visits (AWV) and execution of guided processes to complete the AWV via telephone. Assesses healthcare needs that require additional follow up by primary care provider.

Banner's Wellness in Nursing (WIN) program makes working in healthcare easier, so life can be better for our nurses.

At Banner Medical Group, you'll have the opportunity to perform a critical role in the community where you practice. Banner Medical Group provides both primary and specialty care throughout the communities in which Banner Health operates. We do this in a variety of settings - from smaller group practices like our Banner Health Clinics in Colorado and Wyoming, to large multi-specialty Banner Health Centers in the metropolitan Phoenix area. We currently have more than 1,000 physicians and more than 3,500 total employees in our group and are seeking others to enhance our ability to deliver our nonprofit mission of providing excellent patient care.


This position provides clinical and operational coordination for the Medicare Annual Wellness Visit (AWV) program in support of achieving organizational goals for wellness visit completion and chronic condition (HCC) recapture. This position serves as the subject matter expert on preventive measures, how to close such measures, and documentation and coding for AWVs. This position fosters positive relationships with the patient, primary care physician/APP and others to ensure a good care experience for all.


1. Performs pre-visit planning before each visit to ensure the patient qualifies for an AWV based on Centers for Medicare and Medicaid (CMS) guidelines and to identify open care gaps. Stays up to date with current CMS guidelines and organizational goals and priorities.

2. Performs an in-depth interview with the patient that meets CMS requirements for an AWV. The interview may include advanced care planning, depression screening, health risk assessments, medical and social history, social determinates of health (SDOH) screening, health conditions management and problem list clean up, preventive screenings, patient education, and referral management.

3. Using shared decision-making principles, creates a patient specific care plan that supports the patient's beliefs and values. The plan may include additional follow up with the primary care physician/APP as needed. Assists patients in scheduling appropriate appointments to close care gaps and address AWV findings.

4. Provides appropriate education based on assessment findings and the patient's priorities. Education may include chronic disease management, preventative care strategies and/or community resources.

5. Utilizes standing orders and other clinic efficiencies to optimize care. Ensures proper billing codes are utilize for AWVs for maximum reimbursement.

6. Maintains clear and effective ongoing communication with providers. Methods of communication include documentation in the electronic health record (EHR) and oral communication to ensure continuity of care for patients.

7. Utilizes system tools and resources to assist the provider in reviewing, reconciling, and capturing relevant HCC diagnosis.


Must possess a current, valid RN license in state of practice, temporary RN license in state of practice, or compact RN licensure for current state of practice. Current BLS certification is required for state of practice. Additional certification or continuing education may be required based on area of practice.

Requires a proficiency level typically achieved with two years of clinical experience. Requires excellent organizational skills and clinical knowledge regarding preventive care services, as well as care coordination of services, and the legal and financial aspects of services. Must possess ability to make autonomous decisions utilizing excellent clinical judgment. Must possess highly effective interpersonal and communication skills. Must understand the principles of quality customer service. Requires effective communication and writing skills, good time management skills and knowledge of word processing and database software applications.


Bachelor's degree in nursing preferred.

Recent experience in an ambulatory clinic setting preferred.

Additional related education and/or experience preferred.

EOE/Female/Minority/Disability/Veterans (

Our organization supports a drug-free work environment.

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Banner Health supports a drug-free work environment.

Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability

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