Matron Job - Saint Louis, MO, United States - Optum

Description

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.

The CA 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.

Develop innovative approaches and support the implementation and adoption of new clinical and quality initiatives
Does 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 staff
Utilize 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 clinicians
Oversee and implement clinical staff development programs in collaboration with market leadership
Communicate needs and issues surfaced by clinical staff to site and corporate leadership
Foster and develop a culture of clinical expertise
May lead functional or segment teams and/or projects


PRIMARY CARE DELIVERY:
Deliver cost-effective, quality care to assigned members
Manage both medical and behavioral chronic and acute conditions effectively 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
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
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
Continually 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
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
Participate in CCM quality initiatives

You'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.

For 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 GNP
~ 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
~ 1+ years of Medicare experience
~ Experience in adult teaching environment
~ Proficient computer skills including the ability to document medical information with written and electronic medical records
~ Basic excel skills and/or ability to learn excel

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone.

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.