Nurse Practitioner or Physician Assistant - New Tazewell, TN (16023673)
Landmark Health, part of the Optum and UnitedHealth Group family of businesses, 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.
Provides 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.
- Practices in accordance with the respective state laws and regulations governing the practice of advanced practice nursing
- Understands and complies with long-term care policies and procedures, including those that regulate nursing facilities and assisted living communities
- Establishes and maintains effective relationships with members and their legal representatives, facility staff, PCPs and other collaborating physicians/providers
- Performs 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 meetings
- Completes follow-up and post-hospital assessments according to documented standard operating procedure
- Prescribes appropriate diagnostics and interventions to avoid unnecessary transfers/acute admissions
- Consults with hospital physicians following notification of member transfer
- Collaborates with UM staff and PCPs/facility staff to enable medical necessity determinations for requested medical services
- Educates members and/or their legal representatives in disease processes affecting members and ways to manage them effectively, as well as to promote wellness
- Provides counsel, support and education to facility staff
- Supports FCMs in developing and providing in-service educational programs to facility staff
- Participates in management meetings that include, but may not be limited to:
- Weekly case conference reviews
- Monthly staff meetings
- Schedule Joint Operating Committee meetings
- Quarterly Quality Improvement Committee meetings
- Continuing education/journal club programs
- Implements 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 delivery
- On-call for caseload during business hours. May require some participation in clinical on-call program as plan expands
- Keeps current on relevant medical and nursing research, technology, and related issues by attending continuing education courses, professional meetings and journal reviews
- Perform 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.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Certificates, Licenses, Registrations:
- Current state professional license
- Current NP or PA license
- Access to reliable transportation; if you are driving a vehicle, you must comply with all the terms of the Landmark Motor Vehicle Safety policy
- Education and/or Experience:
- Completion of Nurse Practitioner or Physicain Assistant accredited program
- Knowledge of long-term care, community resources and cost-effective alternatives regarding patient care delivery systems
- Knowledge of CPT, ICD-9 and HCPC codes
- Knowledge of clinical standards of care
- 2+ years clinical experience
- Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems
- Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
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.