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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.
- 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.
- 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.
- Strong analytical, critical thinking, and organizational skills.