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Nurse Practitioner
2 months ago
Landmark Health, a part of Optum, is seeking a Nurse Practitioner - Complex Care Specialist to join our team in Philadelphia County, PA.
About the Role:We are looking for a highly skilled and compassionate Nurse Practitioner to provide high-quality, patient-centered care to our most medically vulnerable members. As a Nurse Practitioner - Complex Care Specialist, you will work collaboratively with our interdisciplinary teams to manage complex patient panels and provide medical care and management to members served by the program.
Responsibilities:- Provide medical care and management to members served by the program
- Collaborate with the Landmark Health Medical Director, Director of Health Services, and UM staff in the development and/or implementation of medical management policy, clinical protocols, utilization management guidelines, and quality management programs
- Establish and maintain effective relationships with members and their legal representatives, facility staff, PCPs, and other collaborating physicians/providers
- Perform an initial comprehensive assessment on all newly enrolled members and bi-annually thereafter
- Develop a member management care plan upon enrollment and updates it as needed when changes in condition warrant or following hospitalization
- Meet with members and/or their legal representatives to review newly developed or modified care plans; involves the PCP in these meetings
- Complete follow-up and post-hospital assessments according to documented standard operating procedure
- Prescribe appropriate diagnostics and interventions to avoid unnecessary transfers/acute admissions
- Consult with hospital physicians following notification of member transfer
- Collaborate with UM staff and PCPs/facility staff to enable medical necessity determinations for requested medical services
- Educate members and/or their legal representatives in disease processes affecting members and ways to manage them effectively, as well as to promote wellness
- Provide counsel, support, and education to facility staff
- Support FCMs in developing and providing in-service educational programs to facility staff
- Participate 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
- Implement 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
- Keep current on relevant medical and nursing research, technology, and related issues by attending continuing education courses, professional meetings, and journal reviews
- Completion of Nurse Practitioner accredited program
- Licensed as NP in state where you will be practicing
- Proven knowledge of long-term care, community resources, and cost-effective alternatives regarding patient care delivery systems
- Proven knowledge of CPT, ICD-9, and HCPC codes
- Proven knowledge of clinical standards of care
- Access to reliable transportation; if you are driving a vehicle, you must comply with all the terms of the Landmark Motor Vehicle Safety policy
- 2+ years clinical experience
- Demonstrated awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems is helpful
Landmark Health is an Equal Employment Opportunity/Affirmative Action employer 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.
