Location: York,PA, USA
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 Clinical Advisor 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 teamAdapt departmental plans and priorities to address business and operational challengesClinically mentor/teach team members as appropriate under the direction of CSMMaintain caseload of 50% or more patients and acquire patients according to team needs in conjunction with clinical advisor dutiesJOB DUTIES:The CA reports to and is supported by the CSM, CTL, or DCOPartner with the manager or supervisor to ensure effective on-boarding of new clinicians and ongoing development of existing cliniciansDevelop innovative approaches and support the implementation and adoption of new clinical and quality initiativesDoes 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 staffUtilize 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 cliniciansOversee and implement clinical staff development programs in collaboration with market leadershipReview work performed by others and provides recommendations for improvement in conjunction with supervisorServe as a resource to APCs/RNs for escalated complex and/or clinical issuesPartner with clinicians and other site functions to ensure business development activities are in place to meet business goalsSought out as knowledge-based expertCommunicate needs and issues surfaced by clinical staff to site and corporate leadershipServe as a leader/ mentorPromote the development of a collegial team, for coverage, troubleshooting and brainstormingFoster and develop a culture of clinical expertiseAnticipate customer needs and proactively develop solutions to meet themSolve complex problems and develop innovative solutions in collaboration with other stakeholdersPerform complex conceptual analysesForecast and plan resource requirementsAuthorize deviations from standardsMay lead functional or segment teams and/or projectsProvide explanations and information to others on complex issuesMotivate and inspire other team membersPRIMARY CARE DELIVERY:Deliver cost-effective, quality care to assigned membersManage both medical and behavioral chronic and acute conditions effectively in collaboration with a physician or specialty providerPerform comprehensive assessments and document findings in a concise/comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulationsEnsuring that all diagnoses are accurate and support the documentation for that visitThe APC is responsible for ensuring that all quality elements are addressed and documentedThe APC will do an initial medication review, annual medication review and a post-hospitalization medication reconciliationFacilitate agreement and implementation of the member's plan of care by engaging the facility staff, families/responsible parties, primary and specialty care physiciansEvaluate the effectiveness, necessity and efficiency of the plan, making revisions as neededUtilizes practice guidelines and protocols established by CCMMay be required to participate in on-call programTravel between care sites mandatoryAfter hour on call coverage may be requiredCARE COORDINATION:Understand the Payer/Plan benefits, CCM associate policies, procedures and articulate them effectively to providers, members and key decision-makersAssess the medical necessity/effectiveness of ancillary services to determine the appropriate initiation of benefit events and communicate the process to providers and appropriate team membersCoordinate care as members transition through different levels of care and care settingsContinually monitor the needs of members and families while facilitating any adjustments to the plan of care as situations and conditions changeReview orders and interventions for appropriateness and response to treatment to identify most effective plan of care that aligns with the member's needs and wishesEvaluate plan of care for cost effectiveness while meeting the needs of members, families and providers to decreases high costs, poor outcomes and unnecessary hospitalizationsPROGRAM 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 groupsActively 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 growthExhibit original thinking and creativity in the development of new and improved methods and approaches to concerns/issuesFunction independently and responsibly with minimal need for supervisionDemonstrate initiative in achieving individual, team and organizational goals and objectivesParticipate in CCM quality initiativesPROFESSIONALISM:Personal and Professional Accountability:Create an environment that facilitates the team to initiate actions that produce positive resultsAbility to hold self and others accountable for actions and results in collaboration with CSM/CTL/DCOAnswers for one's own behavior and actionsCareer Planning:Develops own career pathCoach others in the development of their career planningEthics:Integrate high ethical standards and UHG core values into everyday work activitiesYou'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 boardFor 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 GNPActive and unrestricted license in the state which you resideCurrent active DEA licensure/prescriptive authority or ability to obtain post-hire, per state regulations (unless prohibited in state of practice)3+ years NP experienceAccess to reliable transportation that will enable you to travel to client and/or patient sites within a designated areaAbility to lift a 30-pound bag in and out of car and to navigate stairs and a variety of dwelling conditions and configurationsAbility to gain a collaborative practice agreement, if applicable in your statePreferred Qualifications:2+ years of leadership experience1+ years of Medicare experienceExperience in adult teaching environmentAbility to develop and maintain positive customer relationshipsPossess knowledge and understanding of geriatrics clinical managementAbility to work across functions and businesses to achieve business goalsEffective in motivating and mentoring colleagues and peersAble to quickly adapt to change and drive change management within team and marketPossess a high level of organizational skills, self- motivation, and ability to manage time independentlyProficient computer skills including the ability to document medical information with written and electronic medical recordsBasic excel skills and/or ability to learn ExcelAt 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