Nurse Practitioner - Complex Care Management - Buncombe, Henderson, Haywood Counties NC

Optum
US - North Carolina - Waynesville
January 10, 2025

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 Senior Community Care (SCC) product, we work with a team to provide care to patients at home in a nursing home, assisted living for senior housing.
This life-changing work adds a layer of support to improve access to care.

We're connecting care to create a seamless health journey for patients across care settings.
Join us to start Caring.
Connecting.
Growing together.

We're fast becoming the nation's largest employer of Nurse Practitioners; offering a superior professional environment and incredible opportunities to make a difference in the lives of patients.
This growth is not only a testament to our model's success but the efforts, care, and commitment of our Nurse Practitioners.

Serving millions of Medicare and Medicaid patients, Optum is the nation's largest health and wellness business and a vibrant, growing member of the UnitedHealth Group family of businesses.
You have found the best place to advance your advanced practice nursing career.
As an CCM Nurse Practitioner/ Physician Assistant per diem you will provide care to Optum members and be responsible for the delivery of medical care services in a periodic or intermittent basis.

Primary 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
- 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
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
- Coordinate care as members transition through different levels of care and care settings
- Monitor the needs of members and families while facilitating any adjustments to the plan of care as situations and conditions change
- Review orders and interventions for appropriateness and response to treatment to identify most effective plan of care that aligns with the member's needs and wishes
- Evaluate plan of care for cost effectiveness while meeting the needs of members, families and providers to decreases high costs, poor outcomes and unnecessary hospitalizations
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
- Exhibit original thinking and creativity in the development of new and improved methods and approaches to concerns/issues
- Function independently and responsibly with minimal need for supervision
- Ability to enter available hours into web-based application, at least one month prior to available work time
- Demonstrate initiative in achieving individual, team, and organizational goals and objectives
- Participate in CCM quality initiatives
- Availability to check Optum email intermittently for required trainings, communications, and monthly scheduling

Read the full job description and apply online on the recuiter's web-site

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