Utilization Review Manager - Home Care jobs in Maine

Utilization Review Manager - Home Care ensures quality and level of care for patients are up to established standards and comply with federal, state, and local regulations. Investigates and resolves reports of inappropriate care. Being a Utilization Review Manager - Home Care may require a bachelor's degree. Typically reports to a head of a unit/department. To be a Utilization Review Manager - Home Care typically requires 4 to 7 years of related experience. Contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. (Copyright 2024 Salary.com)

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Care Manager (RN) - Utilization Review
  • MaineHealth
  • Portland, ME FULL_TIME
  • Summary

    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.

    Additional Information

    Maine Medical Center is a Magnet designated 700-bed tertiary care and teaching institution. MMC is Maine's largest hospital and a state-wide health care resource. MMC offers outstanding career opportunities and quality of life in Portland.
  • Just Posted

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Registered Nurse (RN) Care Manager - Utilization Review
  • MaineHealth
  • Belfast, ME FULL_TIME
  • Summary For a limited time MaineHealth is offering up to a $10,000 Sign on bonus for all eligible experienced Registered Nurses with 0-3 years of experience and $20,000 for experienced Registered Nurs...
  • 15 Days Ago

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Registered Nurse (RN) Care Manager - Utilization Review
  • Waldo County General Hospital
  • Belfast, ME FULL_TIME
  • For a limited time MaineHealth is offering up to a $10,000 Sign on bonus for all eligible experienced Registered Nurses with 0-3 years of experience and $20,000 for experienced Registered Nurses with ...
  • 16 Days Ago

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Utilization Review Nurse
  • Martin's Point Health Care
  • Portland, ME FULL_TIME
  • Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," ...
  • 7 Days Ago

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UTILIZATION REVIEW CASE MANAGER
  • Covenant Health
  • Lewiston, ME FULL_TIME
  • JOB SUMMARY Under the supervision of the VP of Patient Care Services/Chief Nursing Officer and directly reporting to the Director of Care Coordination, the UR Case Manager will work collaboratively wi...
  • 24 Days Ago

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RN Care Manager, Care Coordination, Discharge Planning and Utilization Review
  • MaineHealth
  • Biddeford, ME FULL_TIME
  • Summary For a limited time MaineHealth is offering sign on bonuses for Registered Nurses: Registered Nurses with more than 3 years of experience: $20,000 (full time) Eligible candidates are hired into...
  • 1 Month Ago

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Director Utilization Management
  • AMI Network
  • San Diego, CA
  • I’m partnered with a major health plan in San Diego to find a Director of Utilization Management! This top-rated Medicai...
  • 3/28/2024 12:00:00 AM

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Utilities Manager
  • City of Upland, CA
  • Upland, CA
  • Salary : $124,287.53 - $158,625.88 Annually Location : Public Works - 1370 N. Benson Ave Upland, CA Job Type: Full Time ...
  • 3/28/2024 12:00:00 AM

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Utilities Manager (At-Will)
  • City of Rialto, CA
  • Rialto, CA
  • Salary : $116,448.00 - $156,060.00 Annually Location : Rialto, CA Job Type: Full-Time Job Number: 23-072 Department: RUA...
  • 3/28/2024 12:00:00 AM

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Maintenance and Utilities Manager
  • The Judge Group
  • Somerset, NJ
  • Do you love candy and snacks? Are you looking to join an ever evolving and rapidly growing team? PIM Brands might just b...
  • 3/28/2024 12:00:00 AM

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Utilization Management Assistant
  • Trinity Health
  • Des Moines, IA
  • Employment Type: Full timeShift: Description: GENERAL SUMMARY: Under general supervision, the Utilization Management Ass...
  • 3/28/2024 12:00:00 AM

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Utility Manager
  • Prairie Band Potawatomi Nation
  • Mayetta, KS
  • Tier: 2 Department: Administration Supervisor: General Manager of Operations Location: 16281 Q Road, Mayetta KS 66509 Pa...
  • 3/25/2024 12:00:00 AM

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Utility Management Consultant
  • HDR, Inc.
  • Charlotte, NC
  • Qualifications and Experience * BS in Civil or Environmental Engineering or a related technical discipline required. * M...
  • 3/25/2024 12:00:00 AM

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Utilization Management Coordinator
  • Hackensack Meridian Health
  • Point Pleasant Beach, NJ
  • Description: Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients ...
  • 3/25/2024 12:00:00 AM

To the south and east is the Atlantic Ocean and to the north and northeast is New Brunswick, a province of Canada. The Canadian province of Quebec is to the northwest. Maine is both the northernmost state in New England and the largest, accounting for almost half of the region's entire land area. Maine is the only state in the continental US to border only one other American state (New Hampshire to the South and West). Maine is the easternmost state in the United States in both its extreme points and its geographic center. The town of Lubec is the easternmost organized settlement in the United...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Manager - Home Care jobs
$73,301 to $93,454