Utilization Review Registered Nurse

Maine General Health is seeking an experienced Utilization Review Registered Nurse (RN) to join our collaborative Utilization Review team. If you’re an RN who enjoys using your clinical expertise to support appropriate patient care, navigate medical necessity and reimbursement, and work collaboratively with a multidisciplinary team, we want to hear from you!

Our Utilization Review team is a supportive group that works closely together, sharing knowledge and collaborating on clinical and utilization decisions. This position provides an opportunity to use your nursing experience in a role focused on patient care coordination, utilization management, documentation, and reimbursement.

What You’ll Do:

• Reviews admissions and service requests within assigned unit for prospective, concurrent, and retrospective medical necessity and/or compliance with reimbursement policy criteria.
• Assists multidisciplinary teams with issues related to medical records/documentation, pre-certifications, reimbursement and claim denials/appeals.
• Collaborates to assess and coordinate patient’s discharge planning needs with members of the healthcare team.
• Monitors for delays in care and prepares data to reduce length of stay and maximize reimbursement.

What You’ll Bring:

• Current Maine Registered Nurse (RN) license or the ability to obtain Maine licensure in a timely manner.
• Utilization Review or Care Management experience strongly preferred.
• Strong clinical assessment, critical thinking, and decision-making skills.
• Excellent communication and collaboration skills.
• Ability to work independently while contributing effectively as part of a team.
• Knowledge of medical necessity, reimbursement guidelines, and clinical documentation preferred.

Why Maine General?

At Maine General Health, you’ll be part of a team that values collaboration, professional growth, and making a difference in the lives of the patients and communities we serve. We offer competitive benefits, including:

• Medical, dental, and vision insurance
• Generous paid time off
• Retirement plan with employer contribution
• Tuition assistance and professional development opportunities
• Employee wellness programs
• And more!

$39.00 - $68.25

The hourly pay range shown represents the base pay range for this position. Individual pay is determined based on factors such as experience, qualifications, skills, and market considerations. In addition to base pay, eligible team members may earn additional compensation through shift, weekend, holiday, on-call, and other applicable differentials. We are proud to offer a competitive total rewards package designed to recognize our caregivers and support them in delivering exceptional care to the communities we serve.

40

No

Supporting all aspects of our employees’ wellness – physical, emotional and financial – is a critical component of being a great place to work. With the wide range of benefits and programs available, employees have the resources they need to be well at every stage of life and plan for the future.

• We offer quality health, dental, and vision benefits and wellness programs and resources to provide employees access to resources for a healthy lifestyle and help manage health care costs.

• Employees have access to industry-leading leave for new parents.

• A generous earned time plan is offered to all employees - We believe employees need and deserve time away from work to observe holidays, be with family, go on vacation, or simply take care of themselves.

When life gets challenging, employees have access to our Employee Assistance Program for employees and anyone in their household.

• Access the wages…