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Medical Care Specialist

1 month ago

Norwalk, Connecticut, United States Optum Full time

Optum seeks a highly skilled Medical Care Specialist to deliver high-quality, cost-effective care to Medicare and Medicaid patients. As a Senior Community Care (SCC) Nurse Practitioner or Physician Assistant, you will provide medical care services in various settings, including patients' homes.

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
  • 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
  • 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

What We Offer:

  • A competitive salary range: $120,000 - $180,000 per year, based on experience and qualifications
  • An opportunity to work with a leading healthcare company, Optum, in a dynamic environment that challenges and supports your growth
  • A comprehensive benefits package, including medical, dental, and vision insurance, 401(k) matching, and paid time off