$5,000 Sign on Bonus External Candidates

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.

• 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

• For NPs - Certified Nurse Practitioner through a national board
• 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 Practitioners (AG AC NP), Adult/Family or Gerontology Nurse Practitioners (ACNP), with preferred certification as ANP, FNP, or GNP
• For PAs - Certified Physician Assistant through a national board: 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 which you reside
• Current active DEA licensure/prescriptive authority or ability to obtain post-hire, per state regulations (unless prohibited in state of practice)
• 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
• Availability to work 24 hours per month, with expectations that 16 of the 24 hours/month could be during off-hours (after 5 pm, on weekends, and/or holidays) not to exceed 960 hours in a calendar year
• Ability to gain a collaborative practice agreement, if applicable in your state

• 1+ years of hands-on post grad experience within Long Term Care
• Understanding of Geriatrics and Chronic Illness
• Understanding of Advanced Illness and end of life discussions
• Proficient computer skills including the ability to document medical information with written and electronic medical records
• Ability to develop and maintain positive customer relationships
• Adaptability to change