Position Overview:
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.
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 enrolment and updates it as needed when changes in condition warrant or following hospitalization.
- 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 NP or PA license.
- Certification through the American Academy of Nurse Practitioners (AANP), American Nurses Credentialing Center (ANCC), or the National Commission on Certification of Physician Assistants (NCCPA).
- Knowledge of long-term care, community resources and cost-effective alternatives regarding patient care delivery systems.
- 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.
- Knowledge of CPT, ICD-9 and HCPC codes.
- Knowledge of clinical standards of care.
- Awareness of NCQA requirements, CMS guidelines, Medicaid/Medicare contracts and benefit systems.
Compensation and Benefits:
The salary range for this role is $88,000 to $173,200 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable.
What are the reasons to consider working for UnitedHealth Group?
- Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays.
- Medical Plan options along with participation in a Health Spending Account or a Health Saving account.
- Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage.
- 401(k) Savings Plan, Employee Stock Purchase Plan.
- Education Reimbursement.
- Employee Discounts.
- Employee Assistance Program.
- Employee Referral Bonus Program.
- Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.).
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.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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