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Nurse Practitioners - Full time - C & S - Assessments - Greater Boston and surrounding areas - Full-time / Part-time
| Hours | Full-time, Part-time |
|---|---|
| Location | Boston, MA Boston, Massachusetts |
About this job
Community and State is seeking two full time Nurse Practitioners for the following position to cover Greater Boston and surrounding areas.
Primary responsibility includes providing comprehensive assessments of membership that is cared for contracted Nurse Practitioner/Physician Assistant/Primary Care Physician interdisciplinary care teams which includes history, physical examination, medication review, attestation and reconciliation, functional status, laboratory and diagnostic review and accurate diagnosis, coding and care planning.
Responsible for the delivery of medical service to a group of Senior Care Options and Institutional Special Needs Plan enrollees in collaboration with physicians.
Responsible for the establishment and maintenance of effective external relationships with Senior Care Options and Institutional Special Needs Plan enrollees, key decision-makers, facility staff, collaborating physicians and primary NP/PA.
Responsible for the establishment and maintenance of effective internal relationships with the Massachusetts Health Plan clinical team and cross functional team members to build membership and ensure retention of current membership.
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.
Additional responsibilities:
1. Deliver Cost effective quality care to Senior Care Options and Institutional Special Needs Plan enrollees assigned to you in collaboration with contract NP/PA/PCP interdisciplinary care teams.
2. Assist contract NP/PA/PCP and interdisciplinary care team in managing complex behavioral & medical issues by collaborating with primary care physician, Massachusetts Health Plan Medical Director, Clinical Service Manager, Clinical Team Leader or specialty provider as needed.
3. Performs comprehensive assessments and documents findings in a concise/comprehensive manner that is compliant with clinical model visits, documentation requirements, State and Center for Medicare and Medicaid Services (CMS) regulations.
4. Provide leadership and clinical consultation within the care management team concerning clinically complex change in conditions, hospitalizations, chronic illnesses, medication regimes and other clinical situations requiring clinical expertise of Nurse Practitioner/Physician Assistant.
5. Engage the Primary Care Provider and Interdisciplinary care team in consultation as needed to meet the needs of the member.
6. Communicates to the interdisciplinary care teams regarding recommendations for member interventions based on completed assessments.
7. Demonstrates knowledge of HEDIS and quality of care markers
8. Demonstrates knowledge of risk adjusted coding.
9. Ensures proper referral and access of benefits.
10. Deliver cost-effective, quality primary care to assigned Senior Care Options and Institutional Special Needs Plan enrollees.
11. Manage complex behavioral & medical issues in collaboration with primary care physician, Massachusetts Health Plan Medical Director, Clinical Service Manager, Clinical Team Leader or specialty provider.
12. Performs comprehensive assessments and documents findings in a concise/comprehensive manner that is compliant with clinical model visits,documentation requirements, State and Center for Medicare and Medicaid Services (CMS) regulations.
13. 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.
14. Evaluates the effectiveness, necessity, and efficiency of the plan of care and makes revisions as needed.
15. Utilizes practice guidelines and protocols established by Massachusetts Health Plan.
16. Understands the Senior Care Options and Evercare benefits and associate policies and procedures, and articulates them effectively to providers, members, and key decision-makers.
17. 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 the Massachusetts Health plan expectations.
18. Coordinates care as members transition through different levels of care and care settings per Massachusetts Health Plan protocol.
19. Ongoing monitoring of needs of members and families while facilitating any adjustments to the care plan as situations and conditions change
20. Orders and interventions are reviewed for appropriateness and response to treatment to identify most effective plan of care in alignment with the members needs and wishes.
21. 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
22. Regular and effective communication with internal and external parties including physicians, members, key decision-makers, nursing facilities, Massachusetts Health Plan staff and other provider groups.
23. Actively promotes Senior Care Options and Evercare programs in facilities and telephonically by partnering with key stakeholders (ie: internal sales function, provider relations, facility leader) to maintain and develop membership growth.
24. Exhibits original thinking and creativity in the development of new and improved methods and approaches to concerns/issues.
25. Functions independently and responsibly with minimal need for supervision.
26. Demonstrates initiative in achieving individual, team, and organizational goals and objectives.
27. Participates in Massachusetts Health Plan quality initiatives
ICD- 9 experience/knowledge
Medicare / Medicaid knowledge
Managed Care knowledge
Team Player
Requirements
1. Certified nurse practitioner through ANCC/AANP for adult, family, acute care and/or geriatrics (GNP preferred) or the ability to obtain.
2. Current unrestricted license in state(s) in which practicing or the ability to obtain.
3. Proficient computer skills including the ability to document medical information with written and electronic medical records.
4. Unrestricted DEA (license to prescribe narcotics/level II info here) per state regulations (unless prohibited in state of practice) or the ability to obtain.
5. One year of post-grad hands-on Nurse Practitioner experience preferred or relevant nursing experience.
6. Experience in a long term care setting preferred.
Additional assets:
1. Medicare and Medicaid experience preferred
2. Flexibility with schedule and assignment
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.SM
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
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