Hospital Nurse III - Utilization Management

State of Maine • Bangor, ME

19h • $39 - $49

About The Position

This is professional nursing work involving the care and treatment of hospital patients who are emotionally, mentally, or physically ill. The role applies nursing principles, practices, and techniques in patient care and custody. It focuses on utilization management at Dorothea Dix Psychiatric Center (DDPC), including ensuring appropriate, efficient, and medically necessary inpatient care. Supervision may be exercised over professional and paraprofessional personnel, and work is performed under limited supervision.

DDPC is a 69-bed psychiatric hospital serving Maine and providing recovery-oriented, respectful, compassionate, and effective care and treatment for people with severe mental illness. The position may also provide coverage for other disciplines, including Staff Education and the Nursing Department, and participate in ongoing Quality and Performance Improvement initiatives and reporting.

Requirements

• 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.
• Demonstrated critical-thinking skills to process substantial information, assess situations, and make 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 with Hospital Utilization Management.

Responsibilities

• Revise and maintain DDPC’s Utilization Management Plan and ensure adherence to it in accordance with CMS and accreditation, licensing, and regulatory requirements.
• Ensure adherence to record review and certification and 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 admissions and continued hospital stays.
• Collaborate with providers on individual cases and identify 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 in ongoing Quality and Performance Improvement initiatives and reporting.
• Perform special projects and other work within the scope of practice as requested.

Benefits

• 13 paid holidays, 12 days of sick leave, and at least three weeks of vacation leave annually; vacation accrual increases with years of service, and 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 the equivalent of 14.06% of employee pay toward MainePERS retirement.
• 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.
• Additional wellness benefits for State employees.
• Potential eligibility for $200 per month in nursing student loan reimbursement.
• Additional shift differential of $3.00 per hour for second-shift hours and $4.50 per hour for third-shift hours.
• Additional weekend differential of $2.10 per hour for weekend hours.

What This Job Offers

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