Landmark Health, part of the Optum and UnitedHealth Group family of businesses, was created to transform how healthcare is delivered to the most medically vulnerable members in our community. Our medical group provides home-based medical care to chronically ill patients, many of whom are ill-equipped to navigate our overwhelming healthcare system.
Functions as the day-to-day clinical leader of the multi-disciplinary team, providing decision support to team members providing care in the home to Landmark patients
In situations where there is no existing PCP for the patient, the Landmark Physician will assume responsibility as PCP to drive care and continuity for this patient
In situations where there is an existing PCP for the patient, the Landmark Physician helps to co-manage the patient with the PCP and functions as their extension into the home – the PCP’s eye and ears in the home
Assess patients’ needs in their place of residence, including:
Provide 24/7 medical coverage for assigned and covered patients (this can be as part of a call schedule)
Develop and update care plans and documentation of clinical encounters in the electronic medical record as per Landmark’s Medical Records Policies
Provide same-day clinical assessment and treatment for pre-crisis intervention
Participates in management meetings that include, but may not be limited to:
Weekly case conference reviews
Monthly staff meetings
Schedule Joint Operating Committee meetings
Quarterly Quality Improvement Committee meetings
Continuing education/journal club programs
Performs an initial comprehensive assessment on all newly enrolled members and at least annually thereafter. Develops a member management care plan upon enrollment and updates it as needed when changes in condition warrant or following hospitalization. Meets with members and/or their legal representatives to review newly developed or modified care plans; involves the PCP in these meetings
Calls and communicates directly with patient’s PCP in real time to discuss any changes of condition and potential medication changes. Plans will be collaboratively decided on with PCP, but if unable to reach and emergent situation, NP/PA will render appropriate services and communicate changes at first available opportunity
Completes follow-up and post-hospital assessments according to documented standard operating procedure
Prescribes appropriate diagnostics and interventions to avoid unnecessary transfers/acute admissions
Consults with hospital physicians following notification of member transfer
Collaborates with UM staff and PCPs/facility staff to enable medical necessity determinations for requested medical services
Educates members and/or their legal representatives in disease processes affecting members and ways to manage them effectively, as well as to promote wellness
Addresses and documents advanced care planning and advanced directive wishes on initial visit and at least annually thereafter
Implements HEDIS measure campaigns and other quality initiatives as directed by Regional Medical Director to ensure the highest standards of care and to promote the improvement of care management and delivery
Routine caseload during business hours and scheduled on call after hours / weekends with possibility of home visits for crisis interventions
Keeps current on relevant medical and nursing research, technology, and related issues by attending continuing education courses, professional meetings and journal reviews
In addition to routine history and physical exam in the home, will be trained and be proficient at such modalities including, but not limited to:
Insertion of IV
Venipuncture for blood draw
Catheter insertion and management
Demonstrate appropriate medical judgment and appropriate use of resources with regards to care plans, diagnostic testing and referrals
Develop solid patient-doctor and caretaker/family-doctor relationships so as to improve patient compliance with care plan
Work with the NCM to ensure care plan is meeting the clinical and psycho-social needs of the patient
Provide timely, evidence-based and appropriate patient care at all times
Complete and sign all documentation (including from vendors) within required timeframes
Maintain high levels of patient and family satisfaction
Arrange for transfers and placements to appropriate levels of care
Perform other duties as assigned
Medical Doctorate or Doctorate of Osteopathy
Current, valid, non-sanctioned, non-restricted license to practice medicine in the state
Board Certified in Internal Medicine, Geriatrics sub-specialty or Family Practice [Board Eligible for up to 1 year if new grad]
Board Certified or Board Eligible in Internal Medicine, Geriatrics sub-specialty or Family Practice
2+ years of clinical experience, home-based care desired
Extensive experience in providing medical care to geriatrics patients
Familiarity with Medicare Guidelines
Familiarity with CPT and ICD-9 codes as related to billing practices
Ability to meet all Landmark Credentialing Requirements
Access to reliable transportation; if you are driving a vehicle, you must comply with all the terms of the Landmark Motor Vehicle Safety policy
Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
At OptumCare, we’ve found that putting clinicians at the center of care is the best way to improve lives. Our physician-led organization is one of the most dynamic and progressive health care organizations in the world, serving over 17 million people through more than 45,000 aligned physicians and 9,000 advanced practice clinicians. You will find our team working in local clinics, surgery centers and urgent care centers, within care models focused on managing risk, higher quality outcomes and driving change through collaboration and innovation. Learn more at www.workatoptum.com.
Would you thrive with OptumCare?
Do you practice evidence-based medicine?
Are you seeking a practice focused on patient-centered quality care, not volume?
Are you a team player – comfortable delegating and empowering teams?
Are you constantly seeking better ways to do things?
Do you want to be part of something better?
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.