Care Manager RN

$58,300 - $114,300/Yr

UnitedHealth Group - Bangor, ME

Full-time - Mid Level

Remote - Bangor, ME

Insurance Carriers and Related Activities

About the position

The Care Manager, RN plays a crucial role in coordinating patient-centered care across the healthcare continuum. This position involves developing safe discharge plans in collaboration with patients, caregivers, and a multidisciplinary healthcare team, ensuring optimal transitions in care and appropriate post-discharge services. The Care Manager is responsible for improving patient flow, reducing length of stay, and minimizing readmission risks through effective clinical care coordination and resource utilization.

Responsibilities

• Effectively problem-solve and actively pursue resolution.
• Directly communicate with staff, physicians, patients, and families.
• Role model leadership behavior through courtesy, respect, and efficiency.
• Coordinate patient care processes to achieve desired quality outcomes and control inappropriate resource utilization.
• Facilitate patient and family education and promote continuity of care to achieve optimal patient outcomes.
• Review the patient plan of care with the multi-disciplinary team and facilitate care conferences for complex cases.
• Communicate in the medical record and verbally with the team to coordinate interventions and facilitate continuity of care.
• Daily communication and collaboration with patient care staff to provide continuous assessment and planning for appropriate care levels.
• Arrange schedules to facilitate meetings with physicians for patient care rounds and team meetings.
• Adhere to name badge/dress code compliance.
• Demonstrate knowledge of federal and state regulations related to managed care and Medicare health plans.
• Consult with physician section leaders for support in cases of inappropriate continued stay.
• Communicate with the department director regarding length of stay and financial information.
• Integrate assessments for post-hospital services and determine appropriate discharge plans for complex cases.
• Educate patients/families about options within the determined level of care.
• Facilitate timely completion of necessary paperwork for patient transfers.
• Collaborate with physicians, family members, and clinical staff to determine beneficial discharge plans.
• Report relevant information to staff assuming responsibility in the next level of care.
• Interface with department directors and Risk Management to identify potential QA or risk issues.

Requirements

• Associate's Degree (or higher) in Nursing.
• Current, unrestricted RN license in the state of residence.
• 3+ years of experience in a hospital, acute care, or direct care setting.
• Intermediate level of proficiency to type and navigate a Windows based environment.

Nice-to-haves

• Bachelor of Science in Nursing (BSN) (or higher).
• Background in managed care.
• Case management experience.
• Certified Case Manager (CCM).
• Experience or exposure to discharge planning.
• Experience in utilization review and concurrent review.
• Knowledge of community resources, policies, and procedures.
• Knowledge of Utilization Review, Medicare Requirements processes, and State and Federal regulations.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution.