Advanced Practice Clinician
3 weeks ago
Optum, a leading health and wellness company, is seeking a highly skilled Advanced Practice Clinician to join our Senior Community Care team. As a key member of our team, you will play a vital role in delivering high-quality, patient-centered care to our members.
Key Responsibilities- Primary Care Delivery
- Deliver cost-effective, quality care to assigned members
- Manage both medical and behavioral, chronic and acute conditions effectively, and in collaboration with a physician or specialty provider
- Perform comprehensive assessments and document findings in a concise/comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
- Responsible for ensuring that all diagnoses are ICD10, coded accurately, and documented appropriately to support the diagnosis at that visit
- The APC is responsible for ensuring that all quality elements are addressed and documented
- The APC will do an initial medication review, annual medication review and a post-hospitalization medication reconciliation
- Facilitate agreement and implementation of the member's plan of care by engaging the facility staff, families/responsible parties, primary and specialty care physicians
- Evaluate the effectiveness, necessity and efficiency of the plan, making revisions as needed
- Utilizes practice guidelines and protocols established by CCM
- Must attend and complete all mandatory educational and LearnSource training requirements
- Travel between care sites mandatory
- Care Coordination
- Understand the Payer/Plan benefits, CCM associate policies, procedures and articulate them effectively to providers, members and key decision-makers
- Assess the medical necessity/effectiveness of ancillary services to determine the appropriate initiation of benefit events and communicate the process to providers and appropriate team members
- Coordinate care as members transition through different levels of care and care settings
- Monitor the needs of members and families while facilitating any adjustments to the plan of care as situations and conditions change
- Review orders and interventions for appropriateness and response to treatment to identify most effective plan of care that aligns with the member's needs and wishes
- Evaluate plan of care for cost effectiveness while meeting the needs of members, families and providers to decreases high costs, poor outcomes and unnecessary hospitalizations
- Program Enhancement Expected Behaviors
- Regular and effective communication with internal and external parties including physicians, members, key decision-makers, nursing facilities, CCM staff and other provider groups
- Actively promote the CCM program in assigned facilities by partnering with key stakeholders (i.e.: internal sales function, provider relations, facility leader) to maintain and develop membership growth
- Exhibit original thinking and creativity in the development of new and improved methods and approaches to concerns/issues
- Function independently and responsibly with minimal need for supervision
- Ability to enter available hours into web-based application, at least one month prior to available work time
- Demonstrate initiative in achieving individual, team, and organizational goals and objectives
- Participate in CCM quality initiatives
- Availability to check Optum email intermittently for required trainings, communications, and monthly scheduling
- Certified Nurse Practitioner through a national board
- Active and unrestricted license in the state which you reside
- Current active DEA licensure/prescriptive authority / or ability to obtain post-hire, per state regulations (unless prohibited in state of practice)
- Access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area
- Ability to lift a 30-pound bag in and out of car and to navigate stairs and a variety of dwelling conditions and configurations
- Must be available to work a minimum of 10 hours per week.
- Ability to gain a collaborative practice agreement, if applicable in your state
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