MaineCare Complex Case RN

State of Maine•Augusta, ME

7d•$58,219 - $79,331

About The Position

The Complex Case Nurse works in the Complex Case Unit (CCU) within the Office of MaineCare Services at the Maine Department of Health and Human Services. The role uses clinical expertise to support Maine residents of all ages with complex medical, developmental, behavioral, or psychosocial needs. The nurse works with individuals, families, providers, and state agencies to assess needs, coordinate multidisciplinary team meetings, and help establish a path toward resolution so people can navigate complex systems and access appropriate care and services. The CCU works with MaineCare members and other Maine residents facing complex healthcare, financial, and placement challenges. It brings together providers, community partners, and state agencies to coordinate care, address barriers, and develop solutions when usual resources and services have not resolved an individual's needs. This position reports to the Complex Case Manager.

Requirements

Registered Nurse with three years of progressively responsible experience in nursing and/or the delivery of health care services.
Must be licensed as a Registered Professional Nurse in the State of Maine, as issued by the State Board of Nursing.
Ability to work with individuals of all ages who have complex medical, physical, developmental, behavioral, or mental health needs.
Ability to establish and maintain effective working relationships with MaineCare members, families, guardians, healthcare providers, community partners, and organizations while maintaining objectivity and professionalism.
Ability to gather and analyze case information, assess complex situations, identify barriers to care, draw sound conclusions, and make informed decisions independently.
Ability to work independently and as part of a multidisciplinary team to coordinate services, facilitate case discussions, and develop practical solutions to complex challenges.
Strong critical-thinking, problem-solving, communication, organizational, and time-management skills, including the ability to manage competing priorities and recognize when issues require escalation.

Nice To Haves

Two to three years of clinical pediatric and adult experience, or previous case management experience.
Experience with and knowledge of the Medicaid program and/or other health and human services programs serving low-income populations.
Lived experience with Medicaid and/or other health-related social needs common to individuals and families receiving Medicaid coverage.
Familiarity with MaineCare, other state agencies, and statewide community resources that support access to healthcare, services, and safe placement options.

Responsibilities

Provide information, problem-solving assistance, and support to Maine residents, their families, support networks, and healthcare providers.
Facilitate multidisciplinary team meetings for individuals who lack a discharge plan or face other complex challenges; work with involved parties to identify safe placement options and resolve barriers to care.
Coordinate with statewide service providers, community resources, and internal and external DHHS partners to address complex cases and identify solutions.
Escalate complex cases to middle and senior management and consult with leadership as needed.
Build and maintain collaborative relationships with community agencies, hospitals, healthcare providers, MaineCare members, families, and DHHS offices, including OBH, APS, CPS, OCFS, OADS, and programs serving people with brain injuries or intellectual and developmental disabilities.

Benefits

13 paid holidays and at least three weeks of annual vacation leave; vacation accrual increases with years of service.
12 days of sick leave per year.
Personal leave for overtime-exempt employees.
State-paid employee-only health insurance premiums (85%-95%, depending on salary), with a health insurance premium credit that can reduce employee-only premiums by 5%.
State-paid employee-only dental insurance premiums.
State contribution equivalent to 14.06% of employee pay toward MainePERS retirement.
Gym membership reimbursement of up to $40 per month.
Health and dependent care flexible spending accounts.
Eligibility for Public Service Student Loan Forgiveness.
Employee assistance program (Living Resources Program).
Six weeks of fully paid parental leave for employees welcoming a child, including non-birthing and adoptive parents.
Voluntary deferred compensation through a MaineSaves 457(b) account.
Additional wellness benefits for State employees.