Advanced Care Nurse Specialist

2 weeks ago


Newington, Connecticut, United States Optum Full time

Compensation Package: This role offers an estimated $5,000 Sign On Bonus for external candidates and a competitive salary package.

About Us: Optum Home & Community Care is part of the UnitedHealth Group family of businesses, creating something new in healthcare. We unite industry-leading solutions to build an integrated care model that addresses patients' physical, mental, and social needs.

Job Description: As a team member of our Senior Community Care (SCC) product, you will provide care to patients at home, nursing homes, assisted living facilities, or senior housing. You will add a layer of support to improve access to care.

Care Coordination: You will work with a team to understand payer/plan benefits, CCM associate policies, procedures, and articulate them effectively to providers, members, and key decision-makers. You will assess medical necessity/effectiveness of ancillary services, coordinate care as members transition through different levels of care and care settings, and evaluate plan of care for cost-effectiveness while meeting members', families', and providers' needs.

Responsibilities:

  • 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

Requirements: To be successful in this role, you should have a Certified Nurse Practitioner through a national board, graduate of an accredited master's degree in Nursing (MSN) program, and board certified through the American Academy of Nurse Practitioners (AANP) or the American Nurses Credentialing Center (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 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), and ability to gain a collaborative practice agreement, if applicable in your state.



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