Insurance OPT Jobs in Maine

INTRODUCTION

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. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

ROLE AND RESPONSIBILITIES

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.

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, cognitively process and emotionally support performing other duties as assigned
• All employees are expected to remain flexible to meet the needs of the hospital

BASIC QUALIFICATIONS

• Current, unrestricted compact RN License in your 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's Degree (or higher) in Nursing (BSN)
• Case management experience
• Certified Case Manager (CCM) and/or American Case Management Certification (ACM)
• Experience or exposure to discharge planning
• Experience in utilization review and concurrent review
• Cerner EMR experience
• 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

• Solid analytical, critical thinking and organizational skills

COMPENSATION

• 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 salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone - of every race, gender, sexuality, age, location and income - deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

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.