Optum is seeking a Nurse Practitioner or Physician Assistant to join our Home-based Medical Care team in Wilson County, TN. Optum is a clinician-led care organization that is creating a seamless health journey for patients across the care continuum.
As a member of the broader Home and Community Care team, you’ll help bring home-based medical care to complex, chronic patients. This life-changing work helps give older adults more days at home.
At Optum, the integrated medical teams who practice within Home and Community Care are creating something new in health care. Together, we are bringing high-end medical service, compassionate care, and industry-leading solutions to our most vulnerable patient populations. Our holistic approach addresses the physical, mental, and social needs of our patients wherever they may be - helping patients access and navigate care anytime and anywhere. We’re connecting care to create a seamless health journey for patients across care settings. Join our team; it’s your chance to improve the lives of millions while Caring. Connecting. Growing together.
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.
Required Qualifications:
- Completion of Nurse Practitioner or Physician Assistant accredited program.
- Current state professional license.
- Current NP or PA license.
- 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 clinical experience.
- Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems.
Diversity creates a healthier atmosphere: OptumCare 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
#J-18808-Ljbffr
