Case Manager Registered Nurse - Bangor, ME

Optum; Bangor (ME); Presencial; USD 65.000 - 90.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Sign-on bonus

Descripción de la vacante

Optum is seeking a Care Manager, RN to lead coordination of patient-centered care across the continuum. The role develops safe discharge plans, coordinates post-discharge services, and drives efficient utilization of resources to improve patient outcomes and reduce readmission risk. Onsite at Eastern Maine Medical Center in Bangor, ME.

Sign-on bonus of $5,000 is offered. The position emphasizes collaboration with the healthcare team and adherence to regulatory standards to ensure high-quality

Responsabilidades

• 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 identifies/controls inappropriate resource utilization
• Facilitates patient and family education and promotes continuity of care to achieve optimal patient outcomes
• Reviews the patient plan of care with the multi-disciplinary team; facilitates care conferences for complex patients
• Daily communication with patient care staff to provide continuous assessment and continuum planning
• Arrange schedule to facilitate meetings with physicians for patient care rounds and team meetings
• Adheres to name badge/dress code compliance
• Knowledge of managed care and Medicare post-acute services reimbursement and utilization management
• Integrates assessment of post-hospital services and discharge planning for complex cases
• Educates patient/family on options; initiates and ensures completion of paperwork
• Facilitates completion of orders prior to transfer to the next level of care
• Collaborates with physicians, family, social workers, nursing staff, therapists, and payors to determine optimal discharge plan
• Reports on relevant information to staff in the next level of care
• Complies with CMS and Joint Commission Standards
• Ability to coordinate discharge plans for all age groups

Descripción del empleo

OptumInsightis improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, andultimately consumers. Our deepexpertisein the industry and innovative technology empower us to help organizations reduce costs while improving risk management,qualityand revenue growth. Ready to help us deliver results that improve lives? Join us in making healthcare work better for everyone through people-led, responsible AI while 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 patients/caregivers 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.

Sign on bonus of $5.000.00!

This role is an onsite on location at:

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 identifies/controls 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 badge/dress 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 patient/family as to options/choices 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