Case Manager Registered Nurse

UnitedHealth Group•Bangor, ME

5h•Onsite

About The Position

Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start 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.

Requirements

Current, unrestricted Registered Nurse license in the state of Maine
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's Degree (or higher) in Nursing (BSN)
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
Cerner EMR experience
Solid analytical, critical thinking and organizational skills

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. Arrange schedule to facilitate meetings with physicians for patient care rounds, team meetings and other opportunities to improve communication
Adheres to name badge/dress code compliance
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
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 ensures 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 on 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
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
Participates in departmental SQI projects
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