RN Case Manager - Complex Case Coordination
About The Position
The Complex Case Unit (CCU) within the Office of MaineCare Services works with MaineCare and non-MaineCare members to resolve complex healthcare, financial, service coordination, and placement challenges through collaboration with providers, community partners, and state agencies. As an RN Case Manager, you will play a critical role in helping Maine residents of all ages navigate barriers to care and achieve safe, effective outcomes. This position supports individuals with complex, chronic, acute, developmental, behavioral health, and psychosocial needs by coordinating services, facilitating multidisciplinary teams, and identifying solutions when traditional resources have been exhausted. This is an excellent opportunity for an experienced nurse with a background in case management, care coordination, discharge planning, utilization review, community health, managed care, or complex healthcare systems.
Requirements
- Current, active Registered Nurse (RN) license in the State of Maine.
- Three (3) years of progressively responsible nursing experience and/or experience in the delivery of healthcare services.
- Minimum of 2-3 years of clinical experience working with pediatric and adult populations, or prior case management experience.
Nice To Haves
- Case Management
- Care Coordination
- Complex Care Management
- Hospital Discharge Planning
- Utilization Review
- Managed Care
- Community Health Nursing
- Behavioral Health
- Developmental Disabilities Services
- Long-Term Services and Supports (LTSS)
- Medicaid/MaineCare Programs
- Knowledge of physical, developmental, behavioral health, and mental health conditions across the lifespan.
- Experience working with medically complex individuals and vulnerable populations.
- Understanding of MaineCare, Medicaid, healthcare systems, and community-based resources.
- Strong care coordination and interdisciplinary collaboration skills.
- Ability to build productive relationships with members, families, providers, and community partners.
- Strong assessment, analytical, and problem-solving abilities.
- Ability to make informed decisions and prioritize competing demands.
- Exceptional communication, organizational, and facilitation skills.
- Ability to work independently while contributing effectively within a multidisciplinary team environment.
- Proficiency with documentation, case tracking, and healthcare information systems.
Responsibilities
- Serve as a resource and advocate for Maine residents, families, guardians, providers, and support systems facing complex healthcare challenges.
- Assess, coordinate, and monitor services for individuals with chronic, acute, developmental, behavioral health, and medically complex conditions.
- Provide information, consultation, problem-solving assistance, and guidance to members and stakeholders.
- Identify barriers to care and facilitate solutions that promote safe, effective, and person-centered outcomes.
- Lead and facilitate multidisciplinary team meetings to address unresolved healthcare, placement, service delivery, and discharge planning challenges.
- Develop and implement action plans to support successful case resolution.
- Coordinate with statewide resources, community organizations, healthcare systems, and state agencies to address complex member needs.
- Escalate high-risk or sensitive cases to leadership when appropriate.
- Build and maintain collaborative relationships with: Hospitals and healthcare systems, Primary care providers and specialists, Home health and private duty nursing agencies, Behavioral health providers, Community support organizations, MaineCare members and their families, State and local service agencies.
- Partner with internal DHHS and OMS teams, including: Office of Behavioral Health, Adult Protective Services, Child Protective Services, Office of Child and Family Services, Brain Injury Services, Developmental Disability Services.
- Collect, review, and analyze complex case information.
- Evaluate available resources and develop recommendations.
- Maintain accurate case documentation and records.
- Utilize sound clinical judgment and critical thinking to support decision-making.
Benefits
- Medical, Dental, and Vision Insurance
- 401(k) with Discretionary Employer Match
- Paid Time Off (PTO)
- Paid Holidays
- Flexible Spending Accounts (FSA)
- Employee Assistance Program (EAP)
- Employee Discounts and other perks
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
