Advanced Practice Clinician

3 weeks ago

New Milford, Connecticut, United States Optum Full time
Job Summary

Optum, a leading health and wellness company, is seeking a highly skilled Advanced Practice Clinician to join our team. As a key member of our Senior Community Care (SCC) product, you will play a vital role in providing high-quality care to patients in their homes, nursing homes, and assisted living facilities.

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
Requirements
  • Certified Nurse Practitioner through a national board
  • Active and unrestricted license in the State of Connecticut
  • 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
  • Availability to work 24 hours per month, with expectations that 16 of the 24 hours/month could be during off-hours (after 5 pm, on weekends, and/or holidays) not to exceed 960 hours in a calendar year
  • Ability to gain a collaborative practice agreement, if applicable in your state
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 the ability to document medical information with written and electronic medical records
  • Ability to develop and maintain positive customer relationships
  • Adaptability to change

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