Case Manager (RN) - Utilization Review

at MaineHealth in Rockport, Maine, United States

Job Description




Position Summary


The Case Manager provides daily clinically-based care coordination and utilization review management, supporting the delivery of safe patient/family centered care, has accountability for individual patients from admission through discharge.




Nursing expertise and clinical knowledge develop over time and are acquired through experience and exposure to different practice situations. Nurses must utilize multiple ways of thinking in order to cultivate the essential skills of clinical reasoning, critical thinking and clinical judgment. These skills will continue to develop as they progress through the stages of a career on their journey from novice to expert. Competence in these areas develops over a continuum and can be measured throughout each of these stages. The evaluator considers the expected stage of competency when rating the degree to which the nurse is performing.




Stage 1: Novice


Beginners, because they have no experience with the situations in which they are expected to perform, must depend on rules to guide their actions. Following rules, however, has its limits. No rule can tell novices which tasks are most relevant in real life situations. The novice will usually ask to be shown or told what to do.




Stage 2: Advanced Beginner


An advanced beginner is one who has coped with enough real situations to note (or to have them pointed out by a mentor) the recurrent meaningful aspects of situations. An advanced beginner needs help setting priorities since she/he operates on general guidelines and is only beginning to perceive recurrent meaningful patterns. The advanced beginner cannot reliably sort out what is most important in complex situations and will require help to prioritize.




Stage 3: Competent


Typically, the competent professional has been in practice two or three years. This person can rely on long-range goals and plans to determine which aspects of a situation are important and which can be ignored. The competent professional lacks the speed and flexibility of someone who has reached the proficient level, but competence is characterized by a feeling of mastery and the ability to cope with and manage contingencies of practice.




Stage 4: Proficient


This is someone who perceives a situation as a whole rather than in terms of parts. With holistic understanding, decision-making is less labored since the professional has a perspective on which of the many attributes and aspects present are the important ones. The proficient performer considers fewer options and hones in on the accurate region of the problem.




Stage 5: Expert


The expert professional is one who no longer relies on an analytical principle (rule, guideline, and maxim) to connect an understanding of the situation to an appropriate action. With an extensive background of experience, the expert has an intuitive grasp of the situation and focuses in on the accurate region of the problem without wasteful consideration of a larger range of unfruitful possibilities. (Adapted from Benner, 1984, pp. 13-34)


Required Minimum Knowledge, Skills, and Abilities (KSAs)


Education: Graduate of an accredited school of Nursing.


License/Certifications: Current/Valid License in the State of Maine as a Registered Professional Nurse. Current BLS Certification.


Experience: Minimum 3-years' current acute care clinical experience is preferred, in areas of discharge planning, case management or utilization review.


Articulates elements of professional practice and demonstrates:


Knowledge of Evidence Based Practice and Patient and Family Centered Care


Understanding of teamwork and collaboration


Effective verbal/written communication skills


Knowledge of process improvement and sound safety strategies


Competence with computer applications


Individuals involved with discharge planning must have knowledge pertaining to:


Clinical and social factors that affect the patient's functional status at discharge


Community resources to meet post-discharge clinical and social needs and assessment skills


Clinical, social, insurance/financial and physical factors that must be considered when evaluating how a patient's expected post-discharge care needs can be met


For a limited time MaineHealth is offering up to $5,000 sign on for New Grad Registered Nurses, $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... For full info follow application link.


MaineHealth values diversity and is an Equal Opportunity/Affirmative Action employer. Federal and state laws prohibit discrimination in employment because of race, color, national origin, religion, age, sex, sexual orientation, disability or veteran status.

Copy Link

Job Posting: 647052

Posted On: Dec 01, 2021

Updated On: Dec 21, 2021