Opportunities at Northern Light Health, in strategic partnership with Optum. Whether you are looking for a role in a clinical setting or supporting those who provide care, we have opportunities for you to make a difference in the lives of those we serve. As a statewide health care system in Maine, we work to personalize and streamline health care for our communities. If the place for you is at a large medical center, a rural community practice or home care, you will find it here. Join our compassionate culture, enjoy meaningful benefits and discover the meaning behind: Caring. Connecting. Growing together.
The Care Manager / Social Worker, as part of a multidisciplinary team, including the patient / family, physicians, nurse’s therapists, and payors ensures the patient’s progress in the acute episode of care through post discharge and is quality driven while being efficient and cost effective. The incumbent interacts with patients, family members, healthcare professionals, and community and state agencies in this effort.
The Care Manager / Social Worker serves as a liaison between the hospital and community agencies or facilities for the exchange of clinical and referral information. The Care Manager / Social Worker reviews high risk patients from a psychosocial and medical perspective and assesses the psychological needs of patients and families and provides information, support, counseling, care management, and referrals to appropriate resources.
The Care Manager / Social Worker and RN Care Manager work collaboratively to ensure patient needs are met and care delivery is coordinated across the continuum. The expertise of the Care Manager / Social Worker is sought to resolve psychosocial patient care issues and to develop complex patient transition / discharge plan as needed.
The Care Manager / Social Worker is responsible for maintaining hospital compliance with the Quality Improvement Organization (QIO) series provides case review to third party payers and assisting in the denial and appeals process as well as assessing quality, levels of care and identifying and reporting potential risk management issues. The incumbent performs duties and tasks in accordance with performance standards established for the job. The incumbent may have access to highly confidential patient, employee and / or Mercy proprietary information, and must handle & protect the information in accordance with hospital & system policies, HIPAA requirements and the highest level of ethical standards. The incumbent is responsible for reporting all security events, potential events, or other security risks to the organization.
This position is full – time, Monday – Friday. Employees are required to work our normal business hours of 8:00 AM – 4:30 PM EST (Eastern Standard Time zone) including the flexibility to work some holiday coverage based on business need. Our office is located at 489 STATE STREET, BANGOR, ME, 04401. We offer 4 weeks of training.
Works in conjunction with physicians, nurses, Care Management Team and others to assess, plan and initiate patient plan of care
Reviews patient charts
Provides assessment, social services, and counseling to patients and their families in relation to social, psychological, financial, and family situations which will allow timely discharge facilitation
Obtains, interprets, and communicates necessary information regarding patients and families, including social history information, to staff and physicians
Performs clinical assessments and initiates interventions on assigned patients as appropriate to ensure optimal patient outcomes. Should be done through collaboration with multidisciplinary team
Attends Focus of Care rounds per unit schedule
Meets with patients and families to provide psychosocial support as needed
Facilitates and coordinates details of placement and actual discharge to appropriate agencies
Discusses nursing, psychosocial needs and medical information with facilities
Provides and updates referrals to facilities through online/software discharge planning tools
Reviews and completes all appropriate information accompanying patient facility
Acts as a liaison between hospital and those facilities should discharged patients be hospitalized
Arranges time and mode of transportation to facilities for patients
Facilitates and coordinates individualized discharge plan
Arranges and participates in care conferences with unit staff, home care staff, facility staff, patients and / or families
Provides adequate avenues of communication through on – going documentation in MediTech, eDischarge and telephone / verbal reporting or electronic tools
Coordinates and communicates with home care agencies regarding expected standards of care for requested specific treatments and psychosocial needs
Identifies and provides information on requested procedure, medicines and psychosocial needs
Assists patients and families with obtaining community assistance by referral to proper resources
Serves as a resource to physician and hospital personnel regarding available agency, facility, and community services to assist in discharge planning
Develops and maintains good working relationships with outside community health and social agencies
Reaches out to the community to develop new resources for meeting patient needs
Discusses specific continuing care needs with physicians and hospital personnel on a regular basis
Arranges and participates in care conference
Discusses on – going continuing care needs of patients with multidisciplinary team daily.
Completes appropriate State of Maine forms
Monitors the completion of the MED by Goold for all first time Medicaid transfers to nursing facilities
Alerts Goold to complete The MED on Medicaid patients with expired bed holds
Alerts Goold to complete The MED on Medicaid patients with need for community programs
Ensures adherence to Quality Standards
Participates in departmental and hospital Quality Improvement programs
Provides adequate documentation of initial assessments, on – going writing of progress notes and reviewing of all referrals for accuracy and content prior to discharge
Accepts responsibility for further development of professional learning and growth
Medical Record Review:
Assumes integrated Care Management responsibilities when providing department weekend coverage
Conducts inpatient admission reviews for appropriateness of setting
Conducts on – going case review for continued stay criteria and enters data
Monitors quality of care using predetermined criteria
Reports potential risk management issues as through medical record review
Enters data as requested to support Quality Improvement initiatives in Midas
Documents in appropriate electronic system by the close of business each day
Consults with Physician Advisor and leadership as necessary to resolve barriers through appropriate administrative and medical channels
Demonstrates competency in accessing and documentation in Midas, Meditech, Milliman, eDischarge and email system
Identifies patients and families in need of social work services
Performs high – risk screenings
Responds to patient and family request for case work services
Provides psychosocial assessments of the patients and families in relation to the crises of acute and chronic illness
Consult with patient to determine psychosocial concerns and needs.
Meets with family for their input around concerns and needs in relationship to the illness
Reviews medical charts / nurse assessment forms for further insight into patient’s needs
Develops and implements appropriate treatment plans and interventions
Utilizes crisis interventions to mobilize resources in response to crises
Counsels and supports individual, families to help adjust and cope with illness
Make referrals to appropriate community resources
Refers patient and families to appropriate resources regarding insurance issues
Works as in advocate within and without the hospital
Assumes responsibility for own professional growth and on – going education
Seeks opportunities to meet learning needs through workshops and literature
Maintains knowledge of necessary QIO transmittal services to facilitate appropriate level of care and denial activities within the hospital
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Bachelor’s Degree (or higher)
2+ years of clinical experience as a Social Worker in an extended care facility and / OR community healthcare environment
1+ years of experience with insurance coverage and / OR various government programs
Maine Social Worker License
Ability to travel up to 25% of the time
Ability to work any shift between the hours of 8:00 AM – 4:30 PM EST (Eastern Standard Time zone) from Monday – Friday including the flexibility to work some holiday coverage based on business need
Full COVID-19 and Flu vaccination are an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
Direct experience with clinical trial operations, technology and / OR health outcomes research for pharmaceuticals and / OR medical devices
Critical thinking skills
Excellent written and oral skills
Identifies challenges and problem solves with key stakeholders to reach solutions that meet the needs of customers
Drive to consistently meet objectives and maintain focus
Self-directed with proven organizational skills and ability to be flexible and work with ambiguity
Ability to execute on identified deliverables either directly or influencing and driving internal and external partners
Resourcefulness – ability to procure detailed data and information
Proven ability to boil down extensive research findings into relevant insights
Detail-oriented and ability to identify potential risk or problems and recommend path to resolution
Ability to interact one – on – one and consult with all levels of leadership
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies required all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Careers with OptumInsight. Information and technology have amazing power to transform the Healthcare industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life’s best work.SM
**PLEASE NOTE** The sign on bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or related entity in a full time, part time, or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.
Hello! Thanks for contacting the Membership Engagement Team at ACA. While our offices are closed right now - we are happy to chat with you M-F: 8:30am – 5:30pm ET. In the meantime, please feel free to drop us a note at email@example.com – and we will respond when we are back in the office.