• Utilization Review Case Manager

    Covenant Health (Lewiston, ME)


    The starting rate for this position is: $30.32

     

    The rate of pay displayed reflects the beginning of the pay scale. At the time of an offer, the determination of your offer will reflect your skills and experience as it relates to the position.

    Summary

    The UR Case Manager conducts medical necessity reviews per the Utilization Management (UM) plan for patients housed on a nursing unit, including inpatient admissions, patients on observation, and outpatients in a bed. The UR Case Manager identifies delays in care and documents and communicates findings with the care team and the payor, when necessary. The UR case manager also acts as an advocate for the patient and assists in providing information regarding their insurance coverage.

    Job Requirements

    + Bachelor’s degree required.

    + Active State of Maine RN license.

    + Minimum of three years’ experience in utilization review, discharge planning, social work case management, or Utilization Manager experience preferred.

    + Certification as CCM or ACMA-RN preferred.

    + Proficient in Microsoft Office.

    + Strong verbal and written communication skills.

    + Strong interpersonal skills.

    + Ability to work within a stressful, fast-moving environment.

    + Knowledge of community agencies and resources preferred.

    + Knowledge of third-party payer systems.

     

    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, care 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).