Senior Care Coordination Specialist

2 days ago

Rochester, New York, United States Optum Full time
Company Overview

Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is a leading provider of integrated care solutions. We unite industry-leading services to build an innovative care model addressing physical, mental and social needs.

Job Description

As a Senior Care Coordination Specialist, you will play a crucial role in delivering high-quality care to Optum members. You will be responsible for providing medical care services on a periodic or intermittent basis, ensuring that our members receive cost-effective and quality care.

Key Responsibilities
  • Deliver High-Quality Care: Provide comprehensive assessments and document findings in a concise manner, compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations.
  • Manage Medical Conditions: Effectively manage medical and behavioral, chronic and acute conditions, collaborating with physicians or specialty providers as needed.
  • Perform Medication Reviews: Conduct initial, annual, and post-hospitalization medication reviews and reconciliations, ensuring accurate diagnoses and ICD10-coded documentation.
Care Coordination
  • Payer Benefits: Understand Payer/Plan benefits, CCM associate policies, and articulate them effectively to providers, members, and key decision-makers.
  • Ancillary Services: Assess medical necessity and effectiveness of ancillary services, determining the appropriate initiation of benefit events and communicating the process to providers and team members.
  • Member Needs: Monitor member and family needs while facilitating adjustments to the plan of care as situations and conditions change.
Program Enhancement Expected Behaviors
  • Effective Communication: Regularly communicate with internal and external parties, including physicians, members, key decision-makers, nursing facilities, CCM staff, and other provider groups.
  • Growth Promotion: Actively promote the CCM program in assigned facilities by partnering with key stakeholders to maintain and develop membership growth.
  • Independent Work: Function independently and responsibly with minimal need for supervision.
Required Qualifications
  • Licensure: Active and unrestricted license in the state of residence.
  • Certification: Certified Nurse Practitioner or Physician Assistant through a national board.
  • Prescriptive Authority: Current active DEA licensure/prescriptive authority or ability to obtain post-hire.
  • Physical Ability: Ability to lift a 30-pound bag and navigate stairs and various dwelling conditions.
Benefits and Salary

The hourly salary for this role is $51.32-$101.48 per hour, depending on location. UnitedHealth Group complies with all minimum wage laws as applicable. Additional benefits include a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).

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