Per Diem Advanced Practice Clinician - NP or PA, Senior Community Care - Grant, Huntington, Mad

Primary Responsibilities

• 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
• Ensure that all diagnoses are ICD
  10, coded accurately, and documented appropriately to support the diagnosis at that visit
• Ensure that all quality elements are addressed and documented
• Conduct 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
• Utilize practice guidelines and protocols established by CCM
• Attend and complete all mandatory educational and Learn Source training requirements
• Travel between care sites (mandatory)

• 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 the 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 decrease high costs, poor outcomes and unnecessary hospitalizations

• 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 (e.g., internal sales function, provider relations, facility leaders) 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
• 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

Certified Nurse Practitioner (NP) through a national board. For NPs:
Graduate of an accredited master’s degree in Nursing (MSN) program and board certified through the American Academy of Nurse Practitioners (AANP) or the American Nurses Credentialing Center (ANCC), Adult-Gerontology Acute Care Nurse Practitioner (AG AC NP), Adult/Family or Gerontology Nurse Practitioner (ACNP), with preferred certification as ANP, FNP, or GNP. For PAs:
Graduate of an accredited Physician Assistant degree program and currently board certified by the National Commission on Certification of Physician Assistants (NCCPA).

Active and unrestricted license in the state of residence or ability to obtain by start date.

Current active DEA licensure/prescriptive authority or ability to obtain post-hire, per state regulations (unless prohibited in state of practice).

Driver’s license and reliable transportation enabling travel to client and/or patient sites within designated area.

Ability to lift a 30-pound bag in and out of a car and navigate stairs and a variety of dwelling conditions and configurations.

Ability to establish a…