Medical Care Specialist

1 month ago

Westbury, New York, United States UnitedHealth Group Full time

Optum is seeking a skilled Medical Care Specialist to join our Home-based Medical Care team in Queensbury, NY.

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.

We're connecting care to create a seamless health journey for patients across care settings.

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 reviewsMonthly staff meetingsSchedule Joint Operating Committee meetingsQuarterly Quality Improvement Committee meetingsContinuing 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
  • Keeps current on relevant medical and nursing research, technology, and related issues by attending continuing education courses, professional meetings and journal reviews

Required Qualifications:

  • Completion of Nurse Practitioner or Physician Assistant accredited program
  • Current state RN license if Nurse Practitioner
  • 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

Preferred Qualifications:

  • 2+ years of clinical experience
  • Knowledge of CPT, ICD-9 and HCPC codes
  • Knowledge of clinical standards of care
  • Awareness NCQA requirements, CMS guidelines, Medicaid/Medicare contracts and benefit systems

New York Residents Only:The salary range for this role is $88, to $, 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. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

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