Registered Nurse Case Manager

RN Case Manager - Complex Case Coordination Office of MaineCare Services (OMS) | Complex Case Unit (CCU) Hybrid in Augusta, ME The Complex Case Unit (CCU) within the Office of MaineCare Services works with MaineCare and non-MaineCare members to resolve complex healthcare, financial, service coordination, and placement challenges through collaboration with providers, community partners, and state agencies. As an RN Case Manager, you will play a critical role in helping Maine residents of all ages navigate barriers to care and achieve safe, effective outcomes. This position supports individuals with complex, chronic, acute, developmental, behavioral health, and psychosocial needs by coordinating services, facilitating multidisciplinary teams, and identifying solutions when traditional resources have been exhausted. This is an excellent opportunity for an experienced nurse with a background in case management, care coordination, discharge planning, utilization review, community health, managed care, or complex healthcare systems. This position reports to the Complex Case Manager. Primary Responsibilities: Case Management & Care CoordinationServe as a resource and advocate for Maine residents, families, guardians, providers, and support systems facing complex healthcare challenges.Assess, coordinate, and monitor services for individuals with chronic, acute, developmental, behavioral health, and medically complex conditions.Provide information, consultation, problem-solving assistance, and guidance to members and stakeholders.Identify barriers to care and facilitate solutions that promote safe, effective, and person-centered outcomes. Complex Case ResolutionLead and facilitate multidisciplinary team meetings to address unresolved healthcare, placement, service delivery, and discharge planning challenges.Develop and implement action plans to support successful case resolution.Coordinate with statewide resources, community organizations, healthcare systems, and state agencies to address complex member needs.Escalate high-risk or sensitive cases to leadership when appropriate. Collaboration & Relationship ManagementBuild and maintain collaborative relationships with:Hospitals and healthcare systemsPrimary care providers and specialistsHome health and private duty nursing agenciesBehavioral health providersCommunity support organizationsMaineCare members and their familiesState and local service agenciesPartner with internal DHHS and OMS teams, including:Office of Behavioral HealthAdult Protective ServicesChild Protective ServicesOffice of Child and Family ServicesBrain Injury ServicesDevelopmental Disability Services Documentation & AnalysisCollect, review, and analyze complex case information.Evaluate available resources and develop recommendations.Maintain accurate case documentation and records.Utilize sound clinical judgment and critical thinking to support decision-making. Minimum Qualifications: Required:Current, active Registered Nurse (RN) license in the State of Maine.Three (3) years of progressively responsible nursing experience and/or experience in the delivery of healthcare services.Minimum of 2-3 years of clinical experience working with pediatric and adult populations, or prior case management experience. Preferred:Experience in one or more of the following areas:Case ManagementCare CoordinationComplex Care ManagementHospital Discharge PlanningUtilization ReviewManaged CareCommunity Health NursingBehavioral HealthDevelopmental Disabilities ServicesLong-Term Services and Supports (LTSS)Medicaid/MaineCare Programs Preferred Knowledge, Skills, and Abilities: Successful candidates will demonstrate:Knowledge of physical, developmental, behavioral health, and mental health conditions across the lifespan.Experience working with medically complex individuals and vulnerable populations.Understanding of MaineCare, Medicaid, healthcare systems, and community-based resources.Strong care coordination and interdisciplinary collaboration skills.Ability to build productive relationships with members, families, providers, and community partners.Strong assessment, analytical, and problem-solving abilities.Ability to make informed decisions and prioritize competing demands.Exceptional communication, organizational, and facilitation skills.Ability to work independently while contributing effectively within a multidisciplinary team environment.Proficiency with documentation, case tracking, and healthcare information systems. Benefits: SSO offers a comprehensive benefits package designed to support your health, well-being, and financial future, including: Medical, Dental, and Vision Insurance401(k) with Discretionary Employer MatchPaid Time Off (PTO)Paid HolidaysFlexible Spending Accounts (FSA)Employee Assistance Program (EAP)Employee Discounts and other perks Keywords:Registered Nurse (RN), Case Manager, Nurse Case Manager, Complex Case Management, Care Coordination, Care Manager, Clinical Case Manager, Healthcare Case Management, Medicaid, MaineCare, Managed Care, Utilization Review, Discharge Planning, Population Health, Community Health Nursing, Transitional Care, Patient Advocacy, Behavioral Health, Mental Health, Developmental Disabilities, Intellectual Disabilities, Brain Injury Services, Social Determinants of Health, Long-Term Services and Supports (LTSS), Interdisciplinary Team, Multidisciplinary Team, Clinical Assessment, Care Planning, Patient Navigation, Hospital Care Coordination, Community Resources, Chronic Disease Management, Healthcare Administration, Human Services, Social Services, Public Health, Healthcare Operations, Family Support Services, Complex Medical Needs, Vulnerable Populations, Healthcare Collaboration, Quality Outcomes, Resource Coordination, State Government Healthcare Programs.