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NP or PA- HbMC - Primary Care - Delaware, Montgomery, and Philadelphia Counties-PA

Company: Optum
Location: Philadelphia
Posted on: June 8, 2024

Job Description:

$40,000 Student Loan Repayment Or $10,00.00 Sign-on Bonus For Individuals Who Have Not Previously Participated In This Program -
-Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs - helping patients access and navigate care anytime and anywhere. - - -
As a team member of our Landmark product, we help bring home-based medical care to complex, chronic patients. This life-changing work helps give older adults more days at home. - -
We're connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together. - - -
Do you want to make a difference in healthcare?Landmark Health was created to transform how healthcare is delivered to the most medically vulnerable members in our community. Our medical group provides home-based medical care to chronically ill patients, many of whom are ill-equipped to navigate our overwhelming healthcare system.Because many of our patients are frail and elderly, we deliver care primarily in the comfort of their home. Our Program is also offered to eligible patients at no incremental financial cost to them. We are not a fee-for- service practice; we benefit economically only if we deliver high-quality patient outcomes and satisfaction. As a result, our clinical teams can spend quality-time caring for a smaller number of patients, giving all patients the space, respect, compassion and care they deserve.At Landmark, our interdisciplinary teams collaboratively manage our complex patient panels. These teams are led by Physicians, Nurse Practitioners, and Physician Assistants, with supporting care provided by RN Nurse Care Managers, Social Workers, Pharmacists, Behavioral Health, and other employed team members.Join Landmark to be part of a growing company full of purpose-driven, action-oriented, and compassionate team members working to dramatically transform healthcare for our communities.OBJECTIVEProvides medical care and management to members served by the program and participates in gathering clinical information for medical necessity determinations for service requests. Works with the Landmark Health Medical Director, Director of Health Services, Corporate Director of Health Services, and UM staff in the development and/or implementation of medical management policy, clinical protocols, utilization management guidelines, and quality management programs. Dedicated to improving the health and well-being of members, this position collaborates with the PCP, and as needed, the health plan Medical Director and other health professionals, to develop members' goals of care in all phases of long-term care.
Primary Responsibilities: -

Practices in accordance with the respective state laws and regulations governing the practice of advanced practice nursingUnderstands and complies with long-term care policies and procedures, including those that regulate nursing facilities and assisted living communitiesEstablishes and maintains effective relationships with members and their legal representatives, facility staff, PCPs and other collaborating physicians/providersPerforms an initial comprehensive assessment on all newly enrolled members and bi-annually thereafter. Develops a member management care plan upon enrollment and updates it as needed when changes in condition warrant or following hospitalization. Meets with members and/or their -legal representatives to review newly developed or modified care plans; involves the PCP in these meetingsCompletes follow-up and post-hospital assessments according to documented standard operating procedurePrescribes appropriate diagnostics and interventions to avoid unnecessary transfers/acute admissionsConsults with hospital physicians following notification of member transferCollaborates with UM staff and PCPs/facility staff to enable medical necessity determinations for requested medical servicesEducates members and/or their legal representatives in disease processes affecting members and ways to manage them effectively, as well as to promote wellnessProvides counsel, support and education to facility staffSupports FCMs in developing and providing in-service educational programs to facility staffParticipates in management meetings that include, but may not be limited to:
Weekly case conference reviewsMonthly staff meetingsSchedule Joint Operating Committee meetingsQuarterly Quality Improvement Committee meetingsContinuing education/journal club programsImplements HEDIS measure campaigns and other quality initiatives as directed by Corporate Health Services to ensure the highest standards of care and to promote the improvement of care management and deliveryOn-call for caseload during business hours. May require some participation in clinical on-call program as plan expandsKeeps current on relevant medical and nursing research, technology, and related issues by attending continuing education courses, professional meetings and journal reviewsPerform related duties as necessary and other duties as assigned
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. -Required Qualifications: -
Completion of Nurse Practitioner or Physician Assistant accredited programLicensed as a NP or PA-C in State where you will be practicingProven knowledge of long-term care, community resources and cost-effective alternatives regarding patient care delivery systemsProven knowledge of CPT, ICD-9 and HCPC codesProven knowledge of clinical standards of careAccess to reliable transportation; if you are driving a vehicle, you must comply with all the terms of the Landmark Motor Vehicle Safety policy - -
Preferred Qualifications: -
2+ years of clinical experienceAwareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems - -
Competencies: -
Problem Solving - Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions; works well in group problem solving situations; uses reason even when dealing with emotional topicsTechnical Skills - Assesses own strengths and weaknesses; pursues training and development opportunities; strives to continuously build knowledge and skills; shares expertise with othersCustomer Service - Manages difficult or emotional customer situations; responds promptly to customer needs; solicits customer feedback to improve service; responds to requests for service and assistance; meets commitmentsInterpersonal Skills - Focuses on solving conflict; maintains confidentiality; listens to others; keeps emotions under control and overcomes resistance when necessary; remains open to new ideasOral Communication - Speaks clearly and persuasively in positive or negative situations; listens and seeks clarification; responds openly to questions. Must be able to deal with frequent change, delays, or unexpected eventsAttendance/Punctuality - Is consistently at work and on time; ensures work responsibilities are covered when absent; arrives at meetings and appointments on timeDependability - Follows instructions, responds to management direction; takes responsibility for own actions; keeps commitments; commits to long hours of work when necessary to reach goals; completes tasks on time or notifies appropriate person with an alternate planInitiative - Volunteers readily; undertakes self-development activities; seeks increased responsibilities; takes independent actions and calculated risks; looks for and takes advantage of opportunities; asks for and offers help when needed; generates suggestions for improving work and workflow**PLEASE NOTE** Employees must be in an active regular status. Employees must remain in role for a minimum of 12 months from the date of hire /rehire/transfer. -If an employee leaves Home and Community, the student loan repayments will cease. The employee must remain in an Advanced Practice Clinician or Physician role within Home and Community for 36 months to receive the full benefit of the student loan repayments. - - -
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. - -
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-Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected. -
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UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. -

Keywords: Optum, Philadelphia , NP or PA- HbMC - Primary Care - Delaware, Montgomery, and Philadelphia Counties-PA, Other , Philadelphia, Pennsylvania

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