Advanced Practice Clinician

4 weeks ago

Macomb, United States Optum Full time
Job Summary

We are seeking a highly skilled Advanced Practice Clinician to join our team at Optum Home Based Medical Care. As a key member of our Landmark product, you will play a vital role in bringing home-based medical care to complex, chronic patients.

Key Responsibilities
  • Practice in accordance with state laws and regulations governing the practice of advanced practice nursing.
  • Understand and comply with long-term care policies and procedures, including those that regulate nursing facilities and assisted living communities.
  • Establish and maintain effective relationships with members, facility staff, PCPs, and other collaborating physicians/providers.
  • Perform comprehensive assessments on newly enrolled members and bi-annually thereafter, developing a member management care plan upon enrollment and updating it as needed.
  • Complete follow-up and post-hospital assessments according to documented standard operating procedure.
  • Prescribe 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 facility staff on disease processes and ways to manage them effectively.
  • Participate in management meetings to discuss case reviews, staff meetings, and quality improvement initiatives.
Requirements
  • Completion of Nurse Practitioner/Physician Assistant accredited program.
  • Current state NP/PA license.
  • 1+ years of experience in practice as a NP or PA.
  • Knowledge of CPT, ICD-9, and HCPC codes.
  • Knowledge of clinical standards of care.
  • Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
  • Ability to write reports, business correspondence, and procedure manuals.
  • Access to reliable transportation.
Preferred Qualifications
  • 2+ years of clinical experience.
  • Knowledge of long-term care, community resources, and cost-effective alternatives.
  • Awareness of UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems.

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