Nurse Practitioner - Full Time - C & S - Worcester, MA - Full-time / Part-time

We are seeking Nurse Practitioner candidates for coverage in the Worcester area for coverage at four nursing home facilities.

UnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.

We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.

This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent, individuals with the tenacity and the dedication to make things work better for millions of people all over our country.

You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.

The culture is a fit for the person that loves to be part of a team and is flexible.

Position description:

• Responsible for the delivery of medical care service to a pre-designated group of Senior Care Option and Nursing Home plan enrollees in collaboration with designated physicians
  
• Provide continuing primary care management
  
• Responsible for establishment and maintenance of effective external relationships with the Senior Care Options and Nursing Home Plan members, key decision-makers, facility staff, and collaborating physicians
  
• Responsible for establishment and maintenance of effective internal relationships with clinical and cross functional team members to build membership and ensure retention of current membership.

Primary Care Delivery

• Delivers cost-effective, quality care to assigned members in collaboration with their assigned physicians
  
• Manages both medical and behavioral chronic and acute conditions effectively in collaboration with a physician or specialty provider
  
• Performs comprehensive assessments and documents findings in a concise/comprehensive manner that is compliant with visit and documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
  
• Facilitates agreement and implementation of the member's plan of care by engaging the facility staff, families/responsible parties, primary and specialty care physicians while ensuring compliance
  
• Evaluates the effectiveness, necessity, and efficiency of the plan of care and makes revisions as needed
  
• Utilizes practice guidelines and protocols established by the Massachusetts Health Plan
  
• Required to participate in on-call program

Care Coordination

• Understands the Senior Care Options benefits and associate policies and procedures, and articulates them effectively to providers, members, and key decision-makers
  
• Assesses the medical necessity/effectiveness of ancillary services to determine the appropriate initiation of any skilled benefit events and communicates process for providers in accordance with site expectations
  
• Coordinates care as members transition through different levels of care and care settings per Evercare protocol
  
• Ongoing monitoring of needs of members and families while facilitating any adjustments to the care plan as situations and conditions change
  
• Orders and interventions are reviewed for appropriateness and response to treatment to identify most effective plan of care in alignment with the member's needs and wishes
  
• Evaluates plan of care for cost effective services that provide agreed upon outcomes for members, families and providers and decreases high costs, poor outcomes and unnecessary hospitalizations

Program Enhancement

• Regular and effective communication with internal and external parties including physicians, members, key decision-makers, nursing facilities, Evercare staff and other provider groups
  
• Actively promotes the Senior Care Options program in assigned facilities by partnering with key stakeholders (i.e.: internal sales function, provider relations, facility leader) to maintain and develop membership growth
  
• Exhibits original thinking and creativity in the development of new and improved methods and approaches to concerns/issues
  
• Functions independently and responsibly with minimal need for supervision
  
• Demonstrates initiative in achieving individual, team, and organizational goals and objectives
  
• Participates in quality initiatives

• Certified nurse practitioner through ANCC/AANP for adult, family, acute care and/or geriatrics (GNP preferred) or the ability to obtain


• Current unrestricted license in state(s) in which practicing or the ability to obtain


• Proficient computer skills including the ability to document medical information with written and electronic medical records


• Unrestricted DEA (license to prescribe narcotics/level II info here) per state regulations (unless prohibited in state of practice) or the ability to obtain


• One year of post-grad hands-on Nurse Practitioner experience preferred or relevant nursing experience