Optum Complex Care Nurse Practitioner Or Physician Assistant - Miami, Florida

UnitedHealth Group Incorporated

Serving millions of Medicare and Medicaid patients, Optum is the nation’s largest health and wellness business and a vibrant, growing member of the UnitedHealth Group family. We’re also the career home for Nurse Practitioners who bring compassion and passion, energy and focus to their work every day. 


In this role, you will provide primary care to patients in long term care or community settings. You will be responsible for the delivery of medical care services to a pre-designated group of enrollees.

Listen to our NPs describe their work: Nurse Practitioner Video

Key responsibilities of the NP include:


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 NP is responsible for ensuring that all diagnoses are ICD9/ICD10 coded accurately and documented appropriately to support the diagnosis at that visit

·         The NP is responsible for ensuring that all quality elements are addressed and documented

·         The NP 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

·         Evaluate the effectiveness, necessity and efficiency of the plan, making revisions as needed.

·         Utilizes practice guidelines and protocols established by CPM.

·         May be required to participate in on-call program.

·         Travel between care sites mandatory

·         After hour on call coverage may be required


Care Coordination:

·         Understand the Payer/Plan benefits, Optum 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 member’s 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.


 Program Enhancement Expected Behaviors:

·         Regular and effective communication with internal and external parties including physicians, members, key decision-makers, nursing facilities, Optum staff and other provider groups.

·         Actively promote the Optum programs in community (Skilled nursing facility, Assisted living facility, community) by partnering with key stakeholders (i.e.: internal sales function, provider relations, facility leader) to maintain and develop membership caseload.

·         Exhibit original thinking and creativity in the development of new and improved methods and approaches to concerns/issues.

·         Function independently and responsibly with minimal need for supervision.

·         Demonstrate initiative in achieving individual, team and organizational goals and objectives.

·         Participate in Optum quality initiatives.





·         Prior experience as a Nurse Practitioner in a long term care setting or community setting for a minimum of one year preferred.

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


Knowledge & Skills:

·         Understanding of Geriatrics and Chronic Illness

·         Ability to develop and maintain positive customer relationships

·         Adaptability to change

·         Understanding of Advanced Illness and end of life discussions


Licensure Requirement:

·         Certified nurse practitioner through ANCC/AANP for adult, family and/or geriatrics required (GNP preferred).

·         Current unrestricted license in state(s) in which practicing.

·         Unrestricted DEA (license to prescribe narcotics/level II info here) per state regulations (unless prohibited in state of practice).

          Or Board Certified Physician Assistant

Additional Qualifications:

·         Ability to lift up to 40 pounds.

·         Must possess a valid Driver’s License with the ability to travel between nursing homes and/or care settings.


What happens when you join our expanding, Fortune 17 organization?  You will share our mission to improve the health of others and help heal the health care system. You’ll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.  


If you want more meaning in your career - as a clinician or a business professional – take this opportunity and apply.  It’s the first step in a new career that will enable you to do your life’s best work.


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.


Job Keywords: Job, Nurse Practitioner, NP, long term care, LTC, Assisted Living, Nursing Home, Primary Care, Home Health, Home Care, Community


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