Description
At Central Maine Healthcare our team members are committed to providing exceptional care and experiences for our community and for each other every day.
Position Summary:
The Care Manager assesses, plans, implements, and evaluates the needs of patients for discharge planning and utilization review. This includes those who may have Medicare, Medicaid, HMO, or private insurance to cover their stay at various units. Discharge planning is coordinated with physicians, nursing, patients, and significant others who have an ongoing caring relationship with the patient. Utilization review procedures include those stated for discharge planning in addition to knowledge of criteria for Medicare, Medicaid coverage and that of HMO or private insurers.
Essential Duties:
Demonstrates Competency in the Following Areas:
+ Performs all aspects of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors.
+ Communicates with the physician regarding the discharge-planning needs of the patient. Assists the physician to facilitate post-hospital care.
+ Responsible for performing assessments on Medicare, Medicaid, and high-risk patients to determine discharge planning needs; always documents assessments.
+ Communicates daily with admissions personnel regarding admissions and discharges to various units/facilities. Consults other departments as appropriate to collaborate on patient care and performance improvement activities.
+ Initiates ongoing communication with the patient and the patient's family to assess discharge needs. Communicates with family members and caretakers regarding the needs of the patient and anticipated plans. Determines the type of assistance/setting/resources necessary for the patient/family and provides appropriate resources/assistance list of facilities.
+ Interacts professionally with patient/family and involves patient/family in the formation of the plan of care
+ Documents discharge planning in an ongoing manner. Documentation meets current standards and policies.
+ Cooperates with Case Manager's activities with the insurance company, based on information received.
+ Takes appropriate action to recover from a service difficulty, ensuring that the necessary action is taken to affect a resolution to the customer's problem.
+ Maintains and respects the confidentiality of patient/physician/personnel information
+ Participates in Utilization Management Committee, CQI, varying team meetings, and other meetings as appropriate.
+ Mentors, educates, guides, and monitors nursing staff in the delivery of nursing care/practice.
+ Demonstrates knowledge of patient's financial status, diagnosis, and discharge needs.
Responsible for home care needs to be met by the time of discharge, with a goal of arrangements completed 24 hours before discharge when theate of discharge is known.
Education and Experience:
+ Graduate of an accredited school of nursing with up to six (6) months of Registered Nurse experience.
+ Current RN license within the state of practice.
+ Current American Heart Association Healthcare Provider BLS required. BSN or equivalent experience required.
Knowledge, Skills and Abilities:
+ Knowledgeable of criteria for Medicare, Medicaid, HMO, and private insurance coverage.
+ Maintains current knowledge of resources available within the community, and maintains supply of resource materials to be distributed to patients when and how obtain other resources as needed.
+ Demonstrates a commitment to service by consistent attendance and punctuality, scheduling absences according to departmental requirements, and incurring unplanned absences only when unavoidable circumstances exist.
+ Customer Service: Interacts with all individuals in a consistent manner, providing attention, support, and assistance to foster an environment of exceptional personal service.
+ Conducts all work activities with respect for coworkers, including the maintenance of a pleasant and professional environment, fostering calmness during stressful situations.
+ Ability to engage patients and team members utilizing the CMH Experience Standards
I am creating a warming, caring, and non-judgmental environment
I am actively listening and seeking information
I am honest, truthful, and consistent
I am respectful, treating all individuals with dignity and empathy
I am serving as a role model, taking both initiative and ownership when appropriate
I am working collaboratively and demonstrating teamwork
I am resilient and adapt to change in positive ways.
If you are passionate about making a difference and are looking for your next great career opportunity, we look forward to reviewing your application!
AT CENTRAL MAINE HEALTHCARE YOU ARE AT THE CENTER OF EVERYTHING WE DO
Our why, our purpose, drives every decision and action we take as a healthcare system. We strive everyday to deliver exceptional care, and to improve our community. We are a non-profit organization that is breaking the traditional healthcare mold by bringing our patients and their family's high value, low cost, and award-winning care while focusing on creating an exceptional experience for them; all within their communities. To accomplish this, we only hire individuals who are committed to excellence, who embody the principles of our CMH Experience Service Standards, and who are ready to step in and help their fellow team members achieve those exceptional results for our patients, their families, and the community.
Central Maine Healthcare System
The organization is broad in its footprint, with three (3) hospitals in Bridgton, Lewiston, and Rumford, and over 75 individual practices within our Medical Group. Lewiston's Central Maine Medical Center is a certified and award-winning level two trauma center, along with our Central Maine Heart and Vascular Institute and the upcoming highly anticipated launch of our comprehensive state of the art cancer treatment center. Both Bridgton and Rumford Hospitals are four (4) star accredited acute care hospitals, and our Medical Group and Maine Urgent Care Centers have won multiple awards within their specialties. As a system we are a six-time winner of the Leapfrog Safety A Rating since 2019, representing some of the highest quality care and outcomes nationwide. Our awards and accolades are only possible as a result of our commitment to culture, and a focus on safety and inclusion, in each of our patient's experiences and in the experiences we create within our teams.
If you are a person who is looking for a way to give back to your community, to help improve the lives of patients or those who care for our patients, want to be part of a growing organization th
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