Utilization Review Registered Nurse - 40 hours
MaineGeneral Health System
Summary
MaineGeneral 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!
Job description
Job Summary
MaineGeneral 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.
Requirements
- Current Maine Registered Nurse (RN) license or 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
Benefits
- Medical, Dental & Vision
- Generous paid time off
- Retirement plan with employer contribution
- Tuition assistance
- Professional development
- Employee wellness programs
- Employee assistance program
- Short-term disability insurance
- Long-term disability insurance
- Parental leave
- 403(b) matching
- 401(a) retirement plan
- Payactiv earned wage access
Company overview
MaineGeneral Health System is Maine's third largest healthcare system, serving the greater Kennebec Valley region with comprehensive medical services. Founded in 1997 and headquartered in Augusta, Maine, the organization employs approximately 5,000 healthcare professionals across Central Maine. As a leading community healthcare provider, MaineGeneral operates multiple medical facilities including the Alfond Center for Health in Augusta and the Thayer Center for Health in Waterville. The system offers a wide range of specialized services including orthopedics, cancer care, women's health, primary care, surgical services, emergency medicine, and rehabilitation. With an annual revenue of approximately $675 million, MaineGeneral is committed to clinical excellence, patient satisfaction, and community health improvement. The organization's mission focuses on enhancing the health of local residents through accessible, high-quality care while maintaining financial stability and operational efficiency. MaineGeneral Health plays a vital role in Maine's healthcare landscape, providing essential medical services to a diverse patient population across multiple counties.