Wilkes-Barre, Pennsylvania
Manchester, Connecticut
Posted: 09-Jul-24
Location: Grants Pass, Oregon
Salary: Open
Categories:
Internal Number: 139891336
$5,000 Sign on Bonus External Candidates
Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs – helping patients access and navigate care anytime and anywhere.
As a team member of our Senior Community Care (SCC) product, we work with a team to provide care to patients at home in a nursing home, assisted living for senior housing. This life-changing work adds a layer of support to improve access to care.
We’re connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together.
We're fast becoming the nation's largest employer of Nurse Practitioners; offering a superior professional environment and incredible opportunities to make a difference in the lives of patients. This growth is not only a testament to our model's success but the efforts, care, and commitment of our Nurse Practitioners.
Serving millions of Medicare and Medicaid patients, Optum is the nation’s largest health and wellness business and a vibrant, growing member of the UnitedHealth Group family of businesses. You have found the best place to advance your advanced practice nursing career. As an CCM Nurse Practitioner/ Physician Assistant per diem you will provide care to Optum members and be responsible for the delivery of medical care services in a periodic or intermittent basis.
Primary Responsibilities:
- Primary Care Delivery
- Deliver cost-effective, quality care to assigned members
- Manage both medical and behavioral, chronic and acute conditions effectively, and in collaboration with a physician or specialty provider
- Perform comprehensive assessments and document findings in a concise/comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
- Responsible for ensuring that all diagnoses are ICD10, coded accurately, and documented appropriately to support the diagnosis at that visit
- The APC is responsible for ensuring that all quality elements are addressed and documented
- The APC will do an initial medication review, annual medication review and a post-hospitalization medication reconciliation
- Facilitate agreement and implementation of the member’s plan of care by engaging the facility staff, families/responsible parties, primary and specialty care physicians
- Evaluate the effectiveness, necessity and efficiency of the plan, making revisions as needed
- Utilizes practice guidelines and protocols established by CCM
- Must attend and complete all mandatory educational and LearnSource training requirements
- Travel between care sites mandatory
- Care Coordination
- Understand the Payer/Plan benefits, CCM associate policies, procedures and articulate them effectively to providers, members and key decision-makers
- Assess the medical necessity/effectiveness of ancillary services to determine the appropriate initiation of benefit events and communicate the process to providers and appropriate team members
- Coordinate care as members transition through different levels of care and care settings
- Monitor the needs of members and families while facilitating any adjustments to the plan of care as situations and conditions change
- Review orders and interventions for appropriateness and response to treatment to identify most effective plan of care that aligns with the member’s needs and wishes
- Evaluate plan of care for cost effectiveness while meeting the needs of members, families and providers to decreases high costs, poor outcomes and unnecessary hospitalizations
- Program Enhancement Expected Behaviors
- Regular and effective communication with internal and external parties including physicians, members, key decision-makers, nursing facilities, CCM staff and other provider groups
- Actively promote the CCM program in assigned facilities by partnering with key stakeholders (i e : internal sales function, provider relations, facility leader) to maintain and develop membership growth
- Exhibit original thinking and creativity in the development of new and improved methods and approaches to concerns/issues
- Function independently and responsibly with minimal need for supervision
- Ability to enter available hours into web-based application, at least one month prior to available work time
- Demonstrate initiative in achieving individual, team, and organizational goals and objectives
- Participate in CCM quality initiatives
- Availability to check Optum email intermittently for required trainings, communications, and monthly scheduling
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- Certified Nurse Practitioner through a national board
- For NPs: Graduate of an accredited master’s degree in Nursing (MSN) program and board certified through the American Academy of Nurse Practitioners (AANP) or the American Nurses Credentialing Center (ANCC), Adult-Gerontology Acute Care Nurse Practitioners (AG AC NP), Adult/Family or Gerontology Nurse Practitioners (ACNP), with preferred certification as ANP, FNP, or GNP
- Active and unrestricted license in the state which you reside
- Current active DEA licensure/prescriptive authority or ability to obtain post-hire, per state regulations (unless prohibited in state of practice)
- Access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area
- Ability to lift a 30-pound bag in and out of car and to navigate stairs and a variety of dwelling conditions and configurations
- Availability to work 24 hours per month, with expectations that 16 of the 24 hours/month could be during off-hours (after 5 pm, on weekends, and/or holidays) not to exceed 960 hours in a calendar year
- Ability to gain a collaborative practice agreement, if applicable in your state
Preferred Qualifications:
- 1+ years of hands-on post grad experience within Long Term Care
- Understanding of Geriatrics and Chronic Illness
- Understanding of Advanced Illness and end of life discussions
- Proficient computer skills including the ability to document medical information with written and electronic medical records
- Ability to develop and maintain positive customer relationships
- Adaptability to change
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment
