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Case Manager RN

2 months ago

Orono, United States Optum Full time
Opportunities at Northern Light Health , in strategic partnership with Optum. Whether you are looking for a role in a clinical setting or supporting those who provide care, we have opportunities for you to make a difference in the lives of those we serve. As a statewide health care system in Maine, we work to personalize and streamline health care for our communities. If the place for you is at a large medical center, a rural community practice or home care, you will find it here. Join our compassionate culture, enjoy meaningful benefits, and discover the meaning behind: Caring. Connecting. Growing together.

The Care Manager, RN provides leadership in the coordination of patient-centered care across the continuum, develops a safe discharge plan through collaboration with the patients/caregivers and multidisciplinary healthcare team to arrange appropriate post discharge services and optimal transitions in care. Facilitates appropriate LOS, patient experience, and reimbursement for all patients. Develops and maintains collaborative relationships with all members of the healthcare team. Through clinical care coordination drives efficient utilization of resources to reduce length of stay, improve patient flow and throughput, limits variation by applying innovative and evidence-based practice, and to reduce the risk of readmission.

Location : Eastern Maine Medical Center - 489 State St, Bangor, ME

Primary Responsibilities:
  • Effectively problem-solves and actively pursues resolution
  • Directly communicates with staff, physicians, patients, and families
  • Role models leadership behavior through courtesy, respect, and efficiency
  • Coordinates patient care processes to achieve desired quality outcomes and identifies/controls inappropriate resource utilization
  • Facilitates patient and family education and promotes continuity of care to achieve optimal patient outcomes. Assures patient rights by offering a choice when appropriate
  • Reviews the patient plan of care with the multi-disciplinary team. Facilitates and participates in multi-disciplinary team care conferences for patients with complex problems. Communicates in the medical record and verbally with the team to coordinate interventions and facilitate continuity of care
  • Daily communication and collaboration with the patient care staff to provide continuous assessment, evaluation, and continuum planning to assure the patient receives the appropriate level of care at the appropriate time. Facilitates the implementation of nursing interventions as indicated by the multi-disciplinary team plan of care that enhances and compliments the skill level of the nursing staff
  • Functions without direct supervision, utilizing time constructively and organizing assignments for maximum productivity. Arranges schedule to facilitate meeting with physicians for patient care rounds, team meetings and other opportunities to improve communication
  • Adheres to name badge/dress code compliance
Utilization Management:
  • Knowledge of all applicable federal and state regulations. Demonstrates a working knowledge of managed care and Medicare health plans as well as reimbursement related to post-acute services within the continuum of care
  • Consults with physician section leaders for support in cases that continued stay is not appropriate, and case manager is unable to come to resolution by working with assigned physician
  • Responsible for communicating with the department director LOS and financial information, as well as issues that may affect the continuum of care process
Continuum of Care Planning:
  • The CM will be responsible for integrating the assessment of the need for post-hospital services and determination of an appropriate discharge plan for complex cases
  • Educates patient/family as to options/choices within the level of care determined to be appropriate. Initiates and insures completion of all necessary paperwork
  • Facilitates completion of orders as required prior to transfer of patient to the next level of care in a timely manner so discharge is not delayed
  • Continuum of Care planning will emphasize education and collaboration with physicians, family members, clinical social workers, nursing staff, therapists, and case managers from contracted payors when appropriate to determine discharge plan that will be of maximum benefit to the patient. Involve staff from next level of care in the treatment plan as early as possible to promote continuity and collaboration
  • Reports all relevant information to the staff assuming responsibility in the next level of care
  • Employees are expected to comply with all regulatory requirements, including CMS and Joint Commission Standards
Risk Management:
  • Interface with department directors, Risk Management, and patient representatives to identify potential QA or risk issues. Perform any necessary investigation, documentation and follow-up as required
  • Participates in departmental SQI projects
  • Must be able to functionally coordinate and discharge plan for all age groups, including but not limited to the unborn child through geriatric age groups
OTHER DUTIES/RESPONSIBILITIES
  • Ability to effectively read, write, and speak, cognitively process and emotionally support performing other duties as assigned
  • All employees are expected to remain flexible to meet the needs of the hospital, which may include floating to other departments to assist as the patient needs fluctuate
What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
  • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
  • Medical Plan options along with participation in a Health Spending Account or a Health Saving account
  • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
  • 401(k) Savings Plan, Employee Stock Purchase Plan
  • Education Reimbursement
  • Employee Discounts
  • Employee Assistance Program
  • Employee Referral Bonus Program
  • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
  • More information can be downloaded at:
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.

Required Qualifications:
  • Associate's Degree (or higher) in Nursing
  • Current, unrestricted RN license in the state of Maine
  • 3+ years of experience in a hospital, acute care, or direct care setting
  • Intermediate level of ability to type and navigate a Windows based environment
Preferred Qualifications:
  • Bachelor's Degree (or higher) in Nursing (BSN)
  • Background in managed care
  • Case management experience
  • Certified Case Manager (CCM) and/or American Case Management Certification (ACM)
  • Experience or exposure to discharge planning
  • Experience in utilization review and concurrent review
  • Knowledge/understanding of community resources, policies, and procedures
  • Knowledge of Utilization Review, Medicare Requirements processes as well as State and Federal regulations pertaining to Utilization Review and Discharge Planning
Soft Skills:
  • Strong analytical, critical thinking and organizational skills

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. 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. Candidates are required to pass a drug test before beginning employment.

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