Hospital Nurse III - Utilization Management

Professional Nursing Position

This is professional nursing work involving the care and treatment of hospital patients who are emotionally, mentally or physically ill. Responsibilities include applying proper nursing principles, practices, and techniques in the care and custody of patients. Supervision may be exercised over a staff of professional and paraprofessional personnel. Work is performed under limited supervision.

Representative tasks include:

• Per CMS and accreditation, licensing and regulating bodies, revises, maintains and ensures adherence to DDPC's Utilization Management Plan.
• Ensures adherence to record review and certification/recertification.
• Proactively manage inpatient utilization to ensure that medical care is appropriate, efficient, and medically necessary.
• Provides adequate information to third party payors, or designated review agencies to confirm the psychiatric medical necessity of the admission and continued hospital stay.
• Collaborates with providers to discuss individual cases and identifies and refers cases that do not meet established clinical criteria to the Clinical Director.
• Responsible for maintenance of Utilization Management Committee membership, committee meetings and conveyance of relevant data and information to the Medical Staff leadership and appropriate individuals, disciplines or additional committees.
• Provides education regarding Utilization Management.
• Will also provide coverage to other disciplines such as Staff Education and Nursing Department.
• Will participate in Quality and Performance Improvement initiatives and reporting in an ongoing basis.

Knowledges, skills, and abilities required include:

• Demonstrate a high level of critical-thinking skills that allows you to process a large amount of information, discern the overall scope of a situation, and make sound decisions based on the information, experience, and knowledge of systems and your scope of practice.
• Demonstrate good communication skills, exceptional attention to detail, and be able to articulate and employ the Mission, Vision, and Values of DDPC with our staff as well as with community providers.
• This bulletin gives an overview of expectations and requirements that do not encompass all duties or expectations of this position. This position may be asked to complete special projects as well as perform work within scope of practice that is not contained herein.

Minimum qualifications include:

• A bachelor's degree in nursing or related field and two (2) years of professional nursing experience -OR- graduation from an accredited school of nursing and three (3) years of professional nursing experience. Experience must include one (1) year overseeing and providing medical and/or psychiatric nursing care in a hospital facility. Preferred knowledge and experience: Hospital Utilization Management.

Agency information:

Dorothea Dix Psychiatric Center (DDPC) is a 69-bed psychiatric hospital serving the entire State of Maine that provides services for people with severe mental illness. As a member of a statewide community of care givers, DDPC collaborates with individuals with severe and persistent mental illness, their community and personal supports, to provide recovery-oriented, respectful, compassionate, and effective psychiatric care and treatment in the least restrictive, safest, and most therapeutic environment we can create.

The Department of Health and Human Services (DHHS) is dedicated to promoting health, safety, resilience, and opportunity for Maine people. The Department provides health and social services to approximately a third of the State's population, including children, families, older Mainers, and individuals with disabilities, mental illness, and substance use disorders. The Department also promotes public health, operates two state psychiatric hospitals, and provides oversight to health care providers.

Benefits of working for the State of Maine include:

• Work-Life Fit Rest is essential. Take time for yourself using 13 paid holidays, 12 days of sick leave, and 3+ weeks of vacation leave annually. Vacation leave accrual increases with years of service, and overtime-exempt employees receive personal leave.
• Health Insurance Coverage The State of Maine pays 85%-100% of employee-only premiums ($12,213.60 - $14,369.04 annual value), depending on salary. Use this chart to find the premium costs for you and your family, including the percentage of dependent coverage paid by the State.
• Dental Insurance The State of Maine pays 100% of employee-only dental premiums ($365.28 annual value).
• Retirement Plan The State contributes the equivalent of 14.06% of the employee's pay towards the Maine Public Employees Retirement System (MainePERS).
• Parental leave is one of the most important benefits for any working parent. All employees who are welcoming a childincluding non-birthing parents and adoptive parentsreceive six weeks of fully paid parental leave . Additional, unpaid leave may also be available, under the Family and Medical Leave Act.

State employees are eligible for an extensive and highly competitive benefits package, covering many aspects of wellness. Learn about additional wellness benefits for State employees from the Office of Employee Health and Wellness.

Note: Benefits may vary somewhat according to specific collective bargaining agreements and are prorated for anything less than full-time.