Optum - Reidsville, NC
posted 2 months ago
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 Landmark product, we help bring home-based medical care to complex, chronic patients. This life-changing work helps give older adults more days at home. We're connecting care to create a seamless health journey for patients across care settings. Join us to start - Caring. Connecting. Growing together. In this role, you will work as a provider member within the Home-Based Medical Care (HBMC) interdisciplinary team in the direct delivery of home-based medical care for a population within an assigned geography. You will be dedicated to improving the health and well-being of patients, collaborating with the Primary Care Provider (PCP), HBMC interdisciplinary teammates, and consultants, and as needed, the health plan Medical Director and other health professionals, to develop and carry out patients' goals of care in all phases of the patient journey. This position requires practicing in accordance with state laws and regulations governing the practice of advanced practice nursing or physician assistants. You will establish and maintain effective relationships with patients, caregivers, and/or their legal representatives, IDT members, PCPs, and other collaborating physicians/providers. Your responsibilities will include performing initial comprehensive assessments on all newly enrolled patients, developing patient management care plans, completing follow-up and post-discharge assessments, and prescribing appropriate diagnostics and interventions to avoid unnecessary acute admissions. You will also educate patients and/or their legal representatives in disease processes affecting patients and ways to manage them effectively, as well as promote wellness. Additionally, you will actively participate in ongoing meetings pertaining to patient care and clinical excellence, implement HEDIS measure campaigns, and keep current on relevant medical and nursing research, technology, and related issues.