Care Manager - Registered Nurse (RN) - Utilization Review

MaineHealth | Portland, ME

Posted Date 9/06/2018
Description The candidate we’re seeking has experience utilizing both MCG and Inter- Qual guidelines as applied to Utilization Management. This position is not a discharge planning position. Familiarity with commercial payer criteria is a plus. This position requires availability of 7:00pm – 7:00am.

  • Position Summary
    • The Care Manager works collaboratively with interdisciplinary and healthcare team members, both internal and external to the organization to facilitate patient care through effective utilization and monitoring of healthcare resources and assumes a leadership role to achieve desired clinical and financial outcomes. The Care Manager coordinates care and services through the acute care episode and across the continuum.
  • Required Minimum Knowledge, Skills, and Abilities (KSAs)
  • Graduate of approved accredited nursing program required, Bachelors in Nursing requested.

Required to matriculate within one year of hire into a BSN degree program and within five years of hire, will complete the BSN degree. Tuition assistance is available for positions 20 or more hours per week.

  • Licensed as a RN in the State of Maine. Certification in Case Management preferred; required within 6 months of becoming eligible
  • Broad clinical training and work experience sufficient to provide background in clinical management, continuing care and transitions of care.
  • Familiarity with health care insurances and regulations desirable.
  • Demonstrates knowledge of the principles of growth and development over the life span and can identify each patient’s age specific needs.
  • Geographic Region
    Greater Portland/Casco Bay
    Healthcare | Management

    Share this job