NP​/PA - Senior Community Care; Senior Living & Patient Connect; Hamilton & Butler Counties; Hamilton

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - NP/PA
- Optum Senior Community Care (Senior Living & Patient Connect) - Hamilton & Butler Counties (greater Hamilton, OH) (2385106)

NP/PA
- Optum Senior Community Care (Senior Living & Patient Connect) - Hamilton & Butler Counties (greater Hamilton, OH) - 2385106

Optum Home & Community Care, part of the Optum 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) team, we work to provide care to patients at home, in assisted living facilities for senior housing, and in skilled nursing facilities (SNF).

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 settings. Join us to start Caring. Connecting. Growing together.

This unique opportunity is a blended role that supports both Optum’s Senior Community Care Senior Living & SNF Patient Connect Programs. This truly dynamic opportunity will afford you the ability to practice at the peak of your license, in that you will both provide direct acute & chronic care management to patients at home & in assisted living facilities - as well as provide unique, one-time visits designed for United Healthcare members transitioning from hospitalization to a skilled nursing facility (SNF) back home.

This role will support patients throughout the Hamilton & Butler County markets, as well as a small portion of Warren County, within the State of Ohio.

Our Senior Living Program is an integrated care delivery program that coordinates the delivery and provision of clinical care of members, where the Advanced Practice Clinician (APC) provides care to our highest-risk health plan members. 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 Providers.

Our SNF Patient Connect Program focuses on improving care transitions, reducing 30-day hospital readmissions, and enhancing overall patient outcomes during a critical stage in the healthcare journey. The Advanced Practice Clinician (APC) conducts a comprehensive, one-time health assessment in collaboration with the case management team to support effective care coordination. The visit emphasizes accurate and complete documentation of acute and chronic conditions, improved coding accuracy, and increased closure of STAR/HEDIS quality measures, including support for Advanced Care Planning directives.

This position offers the opportunity to work independently across varied care settings, leveraging clinical expertise to improve patient satisfaction, strengthen discharge planning, and enhance post-discharge support. It is a highly rewarding role for clinicians seeking autonomy while making a meaningful difference in the lives of a complex patient population.

• 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, , including:
  • Past medical history review, medication reconciliation, vital signs, and physical exam
  • Evidence-based screenings and point-of-care testing (as appropriate)
• Responsible for ensuring that all diagnoses are ICD
  10, 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
• Must attend and complete all mandatory educational and computer/virtual training requirements
• Travel between care sites mandatory
• Care Coordination
  • Communicate with the patient and necessary team members regarding any medical concerns at the time of your visit
  • Conduct advanced illness and advanced care planning conversations
  • Provide patients and caregivers with counseling and education
• Exhibit…