RN Case Manager: Care Coordination & Discharge Expert

Optum; Bangor (ME); On-site; USD 60,000 - 107,000; Full time

Job summary

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.

This role focuses on care management, transition of care planning, and coordinating patient care across levels of care to ensure safe discharge and post-discharge services.

Qualifications

• Associates degree or higher in nursing.
• Current, unrestricted RN license in the state of employment.
• 3+ years of experience in a hospital, acute care or direct care setting.
• Must be able to type and have the ability to navigate a Windows based environment.

Responsibilities

• Maintains knowledge of care management, coordination changes, utilization review changes, authorization changes, contract changes, regulatory requirements.
• Assess physical, psychosocial, and economic needs for transition of care planning to various levels of care; delegate as needed.
• Document, verify, and validate data to monitor and evaluate interventions and outcomes.
• Interview and collect patient data and chart review related to readmission; notify care team when appropriate.
• Communicate with outpatient providers to enhance continuum of care.
• Incorporate performance improvement and customer service excellence into responsibilities; follow payer guidelines.
• Adhere to hospital policies, procedures, rules, and laws; comply with regulations.
• Own ongoing education and professional growth for NL EMMC requirements.
• Provide leadership in coordinating patient-centered care; develop safe discharge plans with the team.
• Work toward optimal DRG length of stay, patient experience, and reimbursement for patients.
• Promote patient advocacy in an independent care model.
• Perform other duties as assigned.

Skills

RN license

Typing

Windows navigation

Hospital experience

Education

Associates degree

BSN

Job description

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.

This role focuses on care management, transition of care planning, and coordinating patient care across levels of care to ensure safe discharge and post-discharge services.