SummarySign On Bonus Possibility!Position Summary
- The purpose of the Utilization Review Case Manager I position is to support the interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates utilization management, care facilitation and discharge planning functions. This work is performed under general supervision in accordance to the Maine Medical Center (MMC) institutional policies and Care Management Department policies.
The Case Manager I is accountable for a designated patient caseload and plans effectively in order to meet patient needs, manage the length of stay, and promote efficient utilization of resources. Specific functions within this role include but are not limited to:
• Facilitation of the collaborative management of patient care across the continuum, intervening as necessary to address barriers to timely and efficient care delivery, flow and reimbursement
• Application of process improvement methodologies in evaluating outcomes of care
• Support and coaching of clinical documentation efforts
• Coordinating communication with the interdisciplinary care team Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the patient served.
Must demonstrate knowledge of the principles of growth and development as it relates to the different life cycles.
- Required Minimum Knowledge, Skills, and Abilities (KSAs)
- Education: BSN or must matriculate into a BSN program within one year of hire and completion attained within 5 years of hire.
- License/Certifications: Current and valid license to practice as a Registered Nurse in the state of Maine. Professional certification as a Case Manager preferred.
- Experience: One to three years clinical experience in clinical practice area, three to five years preferred.
- Excellent interpersonal communication and negotiation skills.
- Strong analytical, data management and PC skills.
- Working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement preferred.
- Understanding of pre-acute and post-acute venues of care and post-acute community resources preferred.
- Strong organizational and time management skills.
- Ability to work independently and exercise sound judgment in interactions with interprofessional team, payors, and patients and their families.
- Demonstrate commitment to organizational values.
- Perform duties in a manner to promote quality patient care and customer service/satisfaction, while promoting safety, cost efficiency, and a commitment to the quality process.
MaineHealth is a not-for-profit integrated health system consisting of eight local hospital systems, a comprehensive behavioral healthcare network, diagnostic services, home health agencies, and over 19,000 employees. It is the largest health system in northern New England and provides preventive care, diagnosis and treatment to 1.1 million residents in Maine and New Hampshire.
With a career at any of the MaineHealth locations, you'll be working with healthcare professionals that truly value the people around them - both within the walls of the organization and the neighborhoods that surround it. We are deeply invested in the wellbeing of our communities and employees. We believe in fostering a work environment of strong commitment, compassionate caring and continuous improvement. Our care - and the science behind that care - is top rate. Join us and your abilities will be challenged and enhanced as you take your career to another level.
Posting ID: 554844833Posted: 2020-06-24