Los Angeles, California
New York, New York
Portland, Oregon
Southampton, New York
Posted: 20-Aug-24
Location: Springfield, Pennsylvania
Salary: Open
Categories:
Internal Number: 141433781
$40,000 Student Loan Repayment or $20,000 Sign-on Bonus for individuals who have not previously participated in this program.
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 Landmark product, we help bring home-based medical care to complex, chronic patients. This life-changing work helps give older adults more days at home.
We’re connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together.
Do you want to make a difference in healthcare?
Landmark Health was created to transform how healthcare is delivered to the most medically vulnerable members in our community. Our medical group provides home-based medical care to chronically ill patients, many of whom are ill-equipped to navigate our overwhelming healthcare system.
Because many of our patients are frail and elderly, we deliver care primarily in the comfort of their home. Our Program is also offered to eligible patients at no incremental financial cost to them. We are not a fee-for- service practice; we benefit economically only if we deliver high-quality patient outcomes and satisfaction. As a result, our clinical teams can spend quality-time caring for a smaller number of patients, giving all patients the space, respect, compassion and care they deserve.
At Landmark, our interdisciplinary teams collaboratively manage our complex patient panels. These teams are led by Physicians, Nurse Practitioners, and Physician Assistants, with supporting care provided by RN Nurse Care Managers, Social Workers, Pharmacists, Behavioral Health, and other employed team members.
Join Landmark to be part of a growing company full of purpose-driven, action-oriented, and compassionate team members working to dramatically transform healthcare for our communities.
Provides medical care and management to members served by the program and participates in gathering clinical information for medical necessity determinations for service requests. Works with the Landmark Health Medical Director, Director of Health Services, Corporate Director of Health Services, and UM staff in the development and/or implementation of medical management policy, clinical protocols, utilization management guidelines, and quality management programs. Dedicated to improving the health and well-being of members, this position collaborates with the PCP, and as needed, the health plan Medical Director and other health professionals, to develop members’ goals of care in all phases of long-term care.
Primary Responsibilities:
- Practices in accordance with the respective state laws and regulations governing the practice of advanced practice nursing
- Understands and complies with long-term care policies and procedures, including those that regulate nursing facilities and assisted living communities
- Establishes and maintains effective relationships with members and their legal representatives, facility staff, PCPs and other collaborating physicians/providers
- Performs an initial comprehensive assessment on all newly enrolled members and bi-annually thereafter. Develops a member management care plan upon enrollment and updates it as needed when changes in condition warrant or following hospitalization. Meets with members and/or their legal representatives to review newly developed or modified care plans; involves the PCP in these meetings
- Completes follow-up and post-hospital assessments according to documented standard operating procedure
- Prescribes appropriate diagnostics and interventions to avoid unnecessary transfers/acute admissions
- Consults with hospital physicians following notification of member transfer
- Collaborates with UM staff and PCPs/facility staff to enable medical necessity determinations for requested medical services
- Educates members and/or their legal representatives in disease processes affecting members and ways to manage them effectively, as well as to promote wellness
- Provides counsel, support and education to facility staff
- Supports FCMs in developing and providing in-service educational programs to facility staff
- Participates in management meetings that include, but may not be limited to:
- Weekly case conference reviews
- Monthly staff meetings
- Schedule Joint Operating Committee meetings
- Quarterly Quality Improvement Committee meetings
- Continuing education/journal club programs
- Implements HEDIS measure campaigns and other quality initiatives as directed by Corporate Health Services to ensure the highest standards of care and to promote the improvement of care management and delivery
- On-call for caseload during business hours. May require some participation in clinical on-call program as plan expands
- Keeps current on relevant medical and nursing research, technology, and related issues by attending continuing education courses, professional meetings and journal reviews
- Perform related duties as necessary and other duties as assigned
Competency:
To perform the job successfully, an individual should demonstrate the following competencies:
- Problem Solving - Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions; works well in group problem solving situations; uses reason even when dealing with emotional topics
- Technical Skills - Assesses own strengths and weaknesses; pursues training and development opportunities; strives to continuously build knowledge and skills; shares expertise with others
- Customer Service - Manages difficult or emotional customer situations; responds promptly to customer needs; solicits customer feedback to improve service; responds to requests for service and assistance; meets commitments
- Interpersonal Skills - Focuses on solving conflict; maintains confidentiality; listens to others; keeps emotions under control and overcomes resistance when necessary; remains open to new ideas
- Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and seeks clarification; responds openly to questions. Must be able to deal with frequent change, delays, or unexpected events
- Attendance/Punctuality - Is consistently at work and on time; ensures work responsibilities are covered when absent; arrives at meetings and appointments on time
- Dependability - Follows instructions, responds to management direction; takes responsibility for own actions; keeps commitments; commits to long hours of work when necessary to reach goals; completes tasks on time or notifies appropriate person with an alternate plan
- Initiative - Volunteers readily; undertakes self-development activities; seeks increased responsibilities; takes independent actions and calculated risks; looks for and takes advantage of opportunities; asks for and offers help when needed; generates suggestions for improving work and workflow
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:
- Completion of Nurse Practitioner accredited program
- Licensed as NP in State where you will be practicing
- Knowledge of long-term care, community resources and cost-effective alternatives regarding patient care delivery systems
- Knowledge of CPT, ICD-9 and HCPC codes
- Knowledge of clinical standards of care
- Access to reliable transportation; if you are driving a vehicle, you must comply with all the terms of the Landmark Motor Vehicle Safety policy
Preferred Qualifications:
- 2+ years of clinical experience
- Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems
Soft Skills:
- Language Skills:
- Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations
- Ability to write reports, business correspondence, and procedure manuals
- Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public
- Mathematical Skills:
- Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals
- Ability to compute rate, ratio, and percent
- Reasoning Ability:
- Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists
- Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form
- Computer Skills:
- To perform this job successfully, an individual should have knowledge of Windows 2000 and MS Office Word Processing software
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to sit and use hands to finger, handle, or feel
- The employee is required to stand; walk and reach with hands and arms
- The employee must occasionally lift and/or move up to 10 pounds
- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
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.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
