Hospital Nurse III - Utilization Management

State of Maine • Bangor, ME

5d • Onsite

About The Position

This is professional nursing work involving the care and treatment of hospital patients who are emotionally, mentally, or physically ill. The Hospital Nurse III applies nursing principles, practices, and techniques in patient care and custody. The position works under limited supervision and may supervise professional and paraprofessional personnel.

The role focuses on Utilization Management at Dorothea Dix Psychiatric Center (DDPC), a 69-bed psychiatric hospital serving people with severe mental illness across Maine. The nurse maintains and supports the hospital’s Utilization Management Plan, reviews the appropriateness and medical necessity of inpatient care, collaborates with providers and payors, and participates in committee, education, quality, and performance-improvement work. The position may also provide coverage to Staff Education and the Nursing Department, and may be assigned special projects or other work within the scope of practice.

DDPC provides recovery-oriented, respectful, compassionate, and effective psychiatric care in the least restrictive, safest, and most therapeutic environment possible. The Department of Health and Human Services promotes health, safety, resilience, and opportunity for Maine people.

Requirements

• A bachelor’s degree in nursing or a related field and two years of professional nursing experience, or graduation from an accredited school of nursing and three years of professional nursing experience.
• At least one year of experience overseeing and providing medical and/or psychiatric nursing care in a hospital facility.
• High-level critical-thinking skills, including processing substantial information, understanding the overall scope of a situation, and making sound decisions based on information, experience, systems knowledge, and scope of practice.
• Good communication skills and exceptional attention to detail.
• Ability to articulate and employ DDPC’s Mission, Vision, and Values with staff and community providers.

Nice To Haves

• Knowledge of and experience in hospital Utilization Management.

Responsibilities

• Revise, maintain, and ensure adherence to DDPC’s Utilization Management Plan in accordance with CMS and accreditation, licensing, and regulatory requirements.
• Ensure adherence to record review and certification/recertification requirements.
• Proactively manage inpatient utilization to ensure medical care is appropriate, efficient, and medically necessary.
• Provide information to third-party payors or designated review agencies to confirm the psychiatric medical necessity of admission and continued hospital stay.
• Collaborate with providers on individual cases and refer cases that do not meet established clinical criteria to the Clinical Director.
• Maintain Utilization Management Committee membership and meetings, and convey relevant data and information to Medical Staff leadership and appropriate individuals, disciplines, or committees.
• Provide education regarding Utilization Management.
• Provide coverage to other disciplines, including Staff Education and the Nursing Department.
• Participate on an ongoing basis in Quality and Performance Improvement initiatives and reporting.
• Perform special projects and other work within the scope of practice as assigned.
• Apply nursing principles, practices, and techniques in the care and custody of hospital patients.
• May supervise professional and paraprofessional personnel.

Benefits

• 13 paid holidays, 12 days of sick leave, and more than three weeks of vacation leave annually; vacation accrual increases with years of service.
• Overtime-exempt employees receive personal leave.
• The State pays 85%–100% of employee-only health insurance premiums, depending on salary; dependent coverage is also available.
• The State pays 100% of employee-only dental insurance premiums.
• The State contributes an amount equivalent to 14.06% of employee pay toward Maine Public Employees Retirement System (MainePERS).
• Six weeks of fully paid parental leave for employees welcoming a child, including non-birthing and adoptive parents; additional unpaid leave may be available under the Family and Medical Leave Act.
• Eligible candidates may qualify for $200 per month in nursing student loan reimbursement.
• Shift differentials: $3.00 per hour for second-shift hours and $4.50 per hour for third-shift hours.
• Weekend differential of $2.10 per hour for weekend hours.
• Additional wellness benefits are available to State employees.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level