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.The CA is responsible for managing up to approximately one half a case load and for providing mentoring, coaching and support for APCs and RNs in the field. The Clinical Advisor partners with their Clinical Services Manager (CSM), Clinical Team Lead (CTL) or Director of Clinical Operations (DCO) to enhance clinical expertise and adherence to Optum’s clinical model.Primary Responsibilities:
Set team direction, resolve problems, and provide guidance to members of own team
Adapt departmental plans and priorities to address business and operational challenges
Clinically mentor/teach team members as appropriate under the direction of CSM
Maintain caseload of 50% or more patients and acquire patients according to team needs in conjunction with clinical advisor duties
JOB DUTIES
The CA reports to and is supported by the CSM, CTL, or DCO
Partner with the manager or supervisor to ensure effective on-boarding of new clinicians and ongoing development of existing clinicians
Develop innovative approaches and support the implementation and adoption of new clinical and quality initiatives
Does not have direct reports but works in coordination with the CTL, CSM, and/or DCO to enhance clinical expertise and adherence to the clinical model through planning and implementing the orientation and development of APC staff
Utilize advanced clinical nursing expertise, knowledge of geriatric/chronic disease management, and the long-term care industry to provide coaching, mentoring, and role-modeling to new and existing clinicians
Oversee and implement clinical staff development programs in collaboration with market leadership
Review work performed by others and provides recommendations for improvement in conjunction with supervisor
Serve as a resource to APCs/RNs for escalated complex and/or clinical issues
Partner with clinicians and other site functions to ensure business development activities are in place to meet business goals
Sought out as knowledge-based expert
Communicate needs and issues surfaced by clinical staff to site and corporate leadership
Serve as a leader/ mentor
Promote the development of a collegial team, for coverage, troubleshooting and brainstorming
Foster and develop a culture of clinical expertise
Anticipate customer needs and proactively develop solutions to meet them
Solve complex problems and develop innovative solutions in collaboration with other stakeholders
Perform complex conceptual analyses
Forecast and plan resource requirements
Authorize deviations from standards
May lead functional or segment teams and/or projects
Provide explanations and information to others on complex issues
Motivate and inspire other team members
PRIMARY CARE DELIVERY
Deliver cost-effective, quality care to assigned members
Manage both medical and behavioral chronic and acute conditions effectively 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
Ensuring that all diagnoses are accurate and support the documentation for 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
May be required to participate in on-call program
Travel between care sites mandatory
After hour on call coverage may be required
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
Continually 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
Demonstrate initiative in achieving individual, team and organizational goals and objectives
Participate in CCM quality initiatives
PROFESSIONALISM:
Personal and Professional Accountability:
Create an environment that facilitates the team to initiate actions that produce positive results
Ability to hold self and others accountable for actions and results in collaboration with CSM/CTL/DCO
Answers for one’s own behavior and actions
Career Planning:
Develops own career path
Coach others in the development of their career planning
Ethics:
Integrate high ethical standards and UHG core values into everyday work activities
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:
Certified Nurse Practitioner through a national board
For NPs: Graduate of an accredited master’s degree in Nursing (MSN) program or doctor of nursing practice (DNP) 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 which you reside
Current active DEA licensure/prescriptive authority or ability to obtain post-hire, per state regulations (unless prohibited in state of practice)
3+ years NP experience
Access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area
Ability to lift a 30-pound bag in and out of car and to navigate stairs and a variety of dwelling conditions and configurations
Ability to gain a collaborative practice agreement, if applicable in your state
Preferred Qualifications:
2+ years of leadership experience as an APC
1+ years Medicare experience
Experience in adult teaching environment
Ability to develop and maintain positive customer relationships
Possess knowledge and understanding of geriatrics clinical management
Ability to work across functions and businesses to achieve business goals
Effective in motivating and mentoring colleagues and peers
Able to quickly adapt to change and drive change management within team and market
Possess a high level of organizational skills, self- motivation, and ability to manage time independently
Proficient computer skills including the ability to document medical information with written and electronic medical records
Basic excel skills and/or ability to learn excel
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.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 by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment
