General Practice Full-Time position in Chambersburg, Pennsylvania

4 weeks ago

Trenton, New Jersey, United States Optum Full time

Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health 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 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 required; 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 is helpful

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