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 with other members of the healthcare team. The case manager also acts as an advocate for the patient and assists in providing information regarding their insurance coverage.

The UR Nurse Case Manager conducts medical necessity reviews in accordance with the Utilization Management (UM) plan for patients that are housed in a nursing unit, including inpatient admissions, patients receiving observation services, and outpatients in a bed. Identifies delays in care. Documents and communicates findings with the care team and the payor, when necessary.

JOB REQUIREMENTS

EDUCATION

• Associates Degree in nursing required
• Valid State of Maine RN license required
• Case Management certification is desirable

EXPERIENCE

• Minimum 3 years experience in the following areas: utilization review, discharge planning, and/or social work
• Knowledge of third-party payer system

OTHER SKILLS REQUIRED

• Strong clerical, organizational, and time management skills required
• Must be able to communicate effectively with patients, families, interdisciplinary team members, and payer
• Ability to remain objective and impartial

Covenant Health Mission Statement

We are a Catholic health ministry, providing healing and care for the whole person, in service to all in our communities.

Our Core Values:

• Compassion

We show respect, caring, and sensitivity towards all, honoring the dignity of each person, especially the poor, vulnerable, and suffering.

• Integrity

We promote justice and ethical behavior and responsibly steward our human, financial, and environmental resources.

• Collaboration

We work in partnership, dialogue, and shared purpose to create healthy communities.

• Excellence

We deliver all services with the highest level of quality while seeking creative innovation.

Applicants, employees and former employees are protected from employment discrimination based on race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age (40 or older), disability, and genetic information (including family medical history).