? (Apply Now) Case Manager RN - Bangor, ME
Company: Optum
Location: Bangor
Posted on: July 8, 2025
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Job Description:
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. Location: 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 the 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 the 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 for 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/ Responsibility: - 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 What are the reasons to consider working for
UnitedHealth Group? Put it all together – competitive base pay, a
full and comprehensive benefit program, performance rewards, and a
management team who demonstrates their commitment to your success.
Some of our offerings include: - Paid Time Off which you start to
accrue with your first pay period plus 8 Paid Holidays - Medical
Plan options along with participation in a Health Spending Account
or a Health Saving account - Dental, Vision, Life& AD&D
Insurance along with Short-term disability and Long-Term Disability
coverage - 401(k) Savings Plan, Employee Stock Purchase Plan -
Education Reimbursement - Employee Discounts - Employee Assistance
Program - Employee Referral Bonus Program - Voluntary Benefits (pet
insurance, legal insurance, LTC Insurance, etc.) - More information
can be downloaded at: http://uhg.hr/uhgbenefits You’ll be rewarded
and recognized for your performance in an environment that will
challenge you and give you clear directions on what it takes to
succeed in your role as well as provide development for other roles
you may be interested in. Required Qualifications: - Associate's
Degree (or higher) in Nursing - Current, unrestricted RN license in
the state of Maine - 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) -
Background in managed care - 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 -
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 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 $58,800 to
$105,000 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. RPO RED
Keywords: Optum, New England , ? (Apply Now) Case Manager RN - Bangor, ME, Healthcare , Bangor, Northeast