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Care Manager RN

2 months ago


Garland, Maine, United States Optum Full time
About the Role

This is a challenging and rewarding opportunity for a skilled RN Care Manager to join our team at Northern Light Health, in strategic partnership with Optum. As a Care Manager RN, you will play a critical role in coordinating patient-centered care across the continuum, ensuring seamless transitions and optimal outcomes.

Key Responsibilities
  • Develop and implement safe discharge plans in collaboration with patients, caregivers, and multidisciplinary healthcare teams.
  • Facilitate efficient utilization of resources, reducing length of stay, improving patient flow, and limiting variation through innovative and evidence-based practices.
  • Collaborate with healthcare teams to develop and maintain collaborative relationships, promoting effective communication and coordination of care.
  • Interface with department directors, Risk Management, and patient representatives to identify potential QA or risk issues, performing necessary investigations, documentation, and follow-up as required.
  • Participate in departmental SQI projects, ensuring alignment with regulatory requirements, including CMS and Joint Commission Standards.
Requirements
  • 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.