Opportunities at Northern Light Health , in strategic partnership with Optum. Whether you are looking for a role in a clinical setting or supporting those who provide care, we have opportunities for you to make a difference in the lives of those we serve. As a statewide health care system in Maine, we work to personalize and streamline health care for our communities. If the place for you is at a large medical center, a rural community practice or home care, you will find it here. Join our compassionate culture, enjoy meaningful benefits and discover the meaning behind: 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.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
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 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
Risk Management:
Interface with department directors, Risk Management, and patient representatives to identify potential QA or risk issues. Perform any necessary investigation, documentation and follow-up as required
Participates in departmental SQI projects
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
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, which may include floating to other departments to assist as the patient's needs fluctuate
Required Qualifications:
Associate’s degree in Nursing (or higher)
Current, unrestricted RN license in the state of residence
3+ years of experience in a hospital, acute care, or direct care setting
Intermediate level of proficiency to type and navigate a Windows based environment
Preferred Qualifications:
Bachelor of Science in Nursing (BSN) (or higher)
Certified Case Manager (CCM)
Case management experience
Experience or exposure to discharge planning
Experience in utilization review and concurrent review
Background in managed care
Knowledge/understanding of community resources, policies, and procedures
Knowledge of Utilization Review, Medicare Requirements processes as well as State and Federal regulations pertaining to Utilization Review and Discharge Planning
Soft Skills:
Strong analytical, critical thinking and organizational skills
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full‑time employment. We comply with all minimum wage laws as applicable.
Application Deadline:
This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.