Case Manager Registered Nurse

Case Manager Registered Nurse at UnitedHealth Group

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Case Manager Registered Nurse

Bangor Maine

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Case Manager Registered Nurse

Requisition number 2356337

Job category Nursing

Primary location Bangor ME

Date posted 04232026

Overtime status Exempt

Travel No

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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 patientscaregivers 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.

Location Eastern Maine Medical Center - 489 State St Bangor ME

Primary 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 identifiescontrols 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 badgedress code compliance

Utilization Management

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

Continuum of Care Planning

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 patientfamily as to optionschoices 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

Risk Management

Participates in departmental SQI projects

Other Duties

Responsibilities

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

Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide