Remote Optum Utilization Review Jobs in Boca Raton, FL

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The Advanced Practice Provider (APP) I, CareLine is responsible for diagnostic patient care primarily through virtual, remote consultation via video conference or telephone. The incumbent in this role serves as the dispositional authority for after-hours and weekend clinical calls. They are accountable for assessing, diagnosing, treating and precisely documenting patients' physical and psychosocial health status through the collection of health data.
We have a part time weekends position open as well as a full time evenings and Saturdays position available.
ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

• Through virtual video conference or telephone, assesses acute and non-acute clinical problems. Performs and documents physical evaluations and patient histories, analyzes trends in patient conditions and develops, documents and implements a patient management plan based on interpretation of findings. Aids in the development of a plan of care that may include health education, physician referrals, case management referrals and patient/family counseling.
• Plans patient care based on knowledge of the patient population and/or protocol. Considers the patient's cultural background, level of understanding, personality and support systems to anticipate and identify physiological and/or psychological problems. Serves as patient advocate.
• Collects comprehensive and focused data relating to the health needs of patients and families. Analyzes data to determine appropriate health maintenance and/or improvement methods.
• Confers with the patient's PCP and other medical providers to report health data and ensure compliance with guidelines.
• Ensures achievement of optimal patient outcomes through use of Telemedicine. Collaborates with on-call PCP, as needed, to support expected clinical outcomes. Implements the appropriate protocol to attain expected outcomes. Evaluate progress toward expected outcomes.
• Works with key contributors to enhance the quality of telehealth practices and systems through the utilization of data demonstrating program effectiveness and success.
• Communicates using a variety of formats, tools and technologies to build professional relationships and deliver care across the continuum.
• Utilizes appropriate resources to plan and provide services that are safe, effective and financially responsible.
• Provides extraordinary customer service and professionalism to all internal and external customers.
• May also participate in clinical rounds and conferences, risk and quality management programs, clinical and other relevant meetings.
• Adheres to strict departmental goals/objectives, standards of performance, regulatory compliance, quality patient care compliance, policies, and procedures. Practices in accordance with a written or electronic practice agreement.
• Participates with the clinical team in the formulation of telehealth/telemedicine policies, procedures and protocols.
• Initiates/participates in quality improvement activities that result in approved outcomes
• Participates with committee(s) to support growth
• Provides feedback regarding the practice of others to improve patient care
• Coordination of services with other programs
• Performs other duties as assigned and modified at manager's discretion.

KNOWLEDGE, SKILLS AND ABILITIES:

• If supporting patients in Georgia, required to adhere to Georgia state law which requires travel to the State of Georgia on a quarterly basis (or as mandated by law) for onsite observation and medical record review by the respective delegating physician.
• If supporting patients in Tennessee, required to adhere to Tennessee state law which requires travel to the State of Tennessee on a bi-annual (or as mandated by law) basis for onsite observation and medical record review by the respective delegating physician.
• Required to adhere to any other state laws which may require travel for onsite observation by the respective delegating physician.
• Expert-level business acuity
• Expert knowledge and understanding of general/core job-related functions, practices, processes, procedures, techniques and methods
• Knowledge and understanding of medical practices to function independently as a certified practitioner and in collaboration and consultation with licensed physicians, specialists and other medical providers
• Demonstrated record of consistently achieving clinical performance metrics
• Technical capability to conduct telemedicine visits in accordance with state and federal regulations
• Ability to demonstrate excellent clinical judgement
• Ability to problem solve
• Ability to prioritize and work under pressure
• Ability to provide constructive feedback
• Ability to communicate and collaborate with physicians, patients and other team members in a professional manner
• Ability to operate effectively with a multidisciplinary team
• Proficient skill in Microsoft Office Suite products including Excel, Word, PowerPoint and Outlook; competent in keyboarding and other systems required for the position
• Ability and willingness to travel to attend meetings and trainings up to 10% of the time. Depending on the assigned schedule required availability to work evenings/overnights and/or weekends.
• Ability and willingness to travel to Georgia or any other state that requires a quarterly onsite observation and medical records review with the respective physician. Minimum requirement to work four holidays in the calendar year.
• Spoken and written fluency in English; bilingual (Spanish/Creole) a plus
• This job requires use and exercise of independent judgment
• Ability and willingness to obtain independent/autonomous practice as an NP in applicable states
• Acquires knowledge and skills to maintain expertise in area of practice.

EDUCATION AND EXPERIENCE CRITERIA:

• Bachelor's degree in Nursing (BSN) and graduate of a school of nursing for Advanced Practice Nursing with certification in area of specialty required; Master's degree in Nursing required.
• For NPs: Board certification by AANP or ANCC required
• Basic Life Support (BLS) certification from the American Heart Association or American Red Cross required upon hire.
• Current DEA number from the DEA for schedule II-V controlled substances may be required based on State of practice
• Multi state licensure to include FL, VA, and at least 2 licenses in the following states: GA, MI, MO, OH, PA, TN, TX, IL, KY, LA, KS.
• A minimum of 3 years' acute/primary care clinical work experience required
• A minimum of 2 years' telehealth work experience preferred

PAY RANGE:
$111,140 - $158,771 Salary
The posted pay range represents the base hourly rate or base annual full-time salary for this position. Final compensation will depend on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for a bonuses or commissions.
EMPLOYEE BENEFITS
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We're ChenMed and we're transforming healthcare for seniors and changing America's healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We're growing rapidly as we seek to rescue more and more seniors from inadequate health care.
ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people's lives every single day.
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