Medical Care Specialist

1 week ago

Manchester, New Hampshire, United States Optum Full time

About the Job

At Optum Home & Community Care, we're creating a new approach to healthcare. Our team provides medical care to patients in various settings, including nursing homes and assisted living facilities.

Role Overview

This is an exciting opportunity for a certified Nurse Practitioner or Physician Assistant to join our Senior Community Care (SCC) product team. As a Medical Care Specialist, you'll work with a dynamic team to deliver high-quality patient care while promoting health and wellness.

Responsibilities

  • Provide cost-effective, quality care to assigned members
  • Manage both medical and behavioral, chronic and acute conditions effectively, collaborating with physicians or specialty providers
  • Perform comprehensive assessments and document findings in a concise/comprehensive manner compliant with documentation requirements and CMS regulations
  • Ensure diagnoses are accurately coded and documented
  • Facilitate agreement and implementation of the member's plan of care by engaging facility staff, families/responsible parties, primary and specialty care physicians
  • Evaluate the effectiveness, necessity, and efficiency of the plan, making revisions as needed
  • Utilize practice guidelines and protocols established by CCM
  • Attend and complete all mandatory educational and training requirements
  • Travel between care sites

Care Coordination Responsibilities

  • Understand 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 team members
  • Coordinate care as members transition through different levels of care and care settings
  • Monitor needs of members and families while facilitating adjustments to the plan of care as situations change
  • Review orders and interventions for appropriateness and response to treatment to identify the most effective plan of care aligning with the member's needs and wishes

Requirements

  • Certified Nurse Practitioner through a national board
  • For NPs: Graduate of an accredited Master's degree in Nursing (MSN) program and board certified through AANP or ANCC, Adult-Gerontology Acute Care Nurse Practitioners (AG AC NP), Adult/Family or Gerontology Nurse Practitioners (ACNP), with preferred certification as ANP, FNP, or GNP
  • Active and unrestricted license in New Hampshire
  • Current active DEA licensure/prescriptive authority or ability to obtain post-hire
  • Access to reliable transportation
  • Ability to lift 30-pound bag and navigate stairs and varying dwelling conditions
  • Availability to work 24 hours/month with 16 hours during off-hours not exceeding 960 hours/year
  • Ability to gain a collaborative practice agreement if applicable

Preferred Qualifications

  • 1+ years of hands-on post-grad experience within Long Term Care
  • Understanding of Geriatrics and Chronic Illness
  • Understanding of Advanced Illness and end-of-life discussions
  • Proficient computer skills including documentation of medical information
  • Ability to develop and maintain positive customer relationships
  • Adaptability to change

About Us

UnitedHealth Group is committed to helping people live healthier lives and making healthcare more accessible and affordable. We're driven by our mission to help people and communities achieve better health and well-being.

Estimated Salary Range

$75,000 - $100,000 per year, based on location and experience.

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