Loan Review Manager jobs in South Portland, ME

This is a bargaining unit position
Date posted: 01/30/2024

For a limited time MaineHealth is offering up to $10,000 Sign on bonus for all eligible experienced Registered Nurses with 1-3 years of experience and $20,000 for experienced Registered Nurses with greater than 3 years of experience!

• Eligible candidates are hired (offer accepted) into a Full or Part time RN position. Bonus amount prorated for Part time hires, per diem hires are ineligible.
• Current MaineHealth member employees are ineligible; former MaineHealth Members are ineligible until greater than 6 months separation from employment.

Position Summary

• The purpose of the 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.