Case Manager Registered Nurse - Bangor, ME

UnitedHealth Group•Bangor, ME

1d•$60,200 - $107,400•Onsite

About The Position

Optum Insight is hiring a Care Manager, RN to coordinate patient-centered care across the continuum and develop safe discharge plans with patients, caregivers, and the multidisciplinary healthcare team. The role arranges appropriate post-discharge services and transitions, supports appropriate length of stay, patient experience, and reimbursement, and builds collaborative relationships across the care team. Through clinical care coordination, the Care Manager promotes efficient resource use, patient flow and throughput, evidence-based practice, and reduced readmission risk. This is an onsite role at Eastern Maine Medical Center, 489 State St, Bangor, Maine. The position coordinates care and discharge planning for patients across age groups, from unborn children through geriatric patients. The Care Manager supports utilization management, continuum-of-care planning, and risk-management quality projects, and must remain flexible to meet hospital needs. A $5,000 sign-on bonus is offered.

Requirements

Current, unrestricted compact RN license in the state of residence.
At least 3 years of experience in a hospital, acute care, or direct care setting.
Intermediate proficiency typing and navigating a Windows-based environment.
Willingness to work onsite at the Bangor, Maine facility.
Solid analytical, critical-thinking, and organizational skills.

Nice To Haves

Bachelor's degree or higher in Nursing (BSN).
Certified Case Manager (CCM) and/or American Case Management Certification (ACM).
Case management experience.
Experience or exposure to discharge planning.
Experience in utilization review and concurrent review.
Cerner EMR experience.
Knowledge and understanding of community resources, policies, and procedures.
Knowledge of utilization review, Medicare requirements and processes, and state and federal regulations pertaining to utilization review and discharge planning.

Responsibilities

Problem-solve effectively and actively pursue resolution.
Communicate directly with staff, physicians, patients, and families, and model courteous, respectful, and efficient leadership behavior.
Coordinate patient care processes to achieve quality outcomes and identify or control inappropriate resource utilization.
Facilitate patient and family education, promote continuity of care, and support patient rights by offering choices when appropriate.
Review plans of care with the multidisciplinary team and facilitate or participate in care conferences for patients with complex problems.
Document and communicate with the team to coordinate interventions and continuity of care.
Collaborate daily with patient care staff to assess and plan for the appropriate level of care at the appropriate time; facilitate nursing interventions indicated by the multidisciplinary plan.
Work without direct supervision, organize assignments productively, and arrange schedules to support physician rounds, team meetings, and communication.
Maintain name badge and dress code compliance.
Apply knowledge of applicable federal and state regulations, managed care, Medicare health plans, and reimbursement for post-acute services.
Consult physician section leaders when continued stay is not appropriate and resolution cannot be reached with the assigned physician.
Communicate length-of-stay and financial information, as well as issues affecting the continuum-of-care process, to the department director.
Assess the need for post-hospital services and determine appropriate discharge plans for complex cases.
Educate patients and families about appropriate level-of-care options, initiate necessary paperwork, and ensure its completion.
Facilitate timely completion of orders before patient transfer to prevent discharge delays.
Collaborate with physicians, families, clinical social workers, nursing staff, therapists, and contracted-payer case managers as appropriate to determine beneficial discharge plans; involve next-level-of-care staff early when possible.
Report relevant information to staff assuming responsibility at the next level of care.
Comply with regulatory requirements, including CMS and Joint Commission standards.
Participate in departmental SQI projects.
Perform other duties as assigned and remain flexible to meet hospital needs.