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.  

**Work Schedule: Mon-Fri from 8am-5pm ET with additional on-call responsibilities**

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. 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

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
• 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
• 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 / Physician Assistant accredited program
• Current state NP / PA license
• Knowledge of CPT, ICD-9 and HCPC codes
• Knowledge of clinical standards of care
• Knowledge of Windows 2000 and MS Office Word Processing software
• Proven 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
• Proven 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
• Proven 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
• 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 long-term care, community resources and cost-effective alternatives regarding patient care delivery systems
• Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems

Physical Demands:

• 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

Work Environment:

• Noise level is usually moderate