Utilization Review Registered Nurse (RN) 40 hrswk, Days
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Job Location:
Augusta, ME - USA
Monthly Salary:
Not Disclosed
Posted on:
3 days ago
Vacancies:
1 Vacancy
Job Summary
Job Summary:
MaineGeneral Health is seeking an experienced Utilization Review Registered Nurse (RN) to join our collaborative this role you will evaluate the medical necessity and appropriateness of patient care ensuring alignment with clinical guidelines and payer requirements while supporting efficient high-quality outcomes. If you have a passion for service excellence and enjoy working closely with interdisciplinary teams to optimize patient care and resource utilization we want to hear from you!Job Description:
Position: Utilization Review Registered Nurse (RN)
Location: Alfond Center for Health Augusta
Schedule: Full-time (40 hours/week)
Shift: Days (8-4:30) Monday - Friday
What Youll 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 patients 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 Bring:
- Active State of Maine Registered Nurse (RN) license or ability to obtain promptly (required)
- Prior experience in Utilization Review Case Management or Care Coordination (strongly preferred)
- Strong critical thinking communication and organizational skills
- Ability to work independently while collaborating effectively across teams
Why Join MaineGeneral Health:
- Collaborative team-focused work environment
- Meaningful impact on patient outcomes and care efficiency
- Flexible scheduling within a weekday-only schedule
- A health system committed to excellence compassion and community
Scheduled Weekly Hours:
40Scheduled Work Shift:
Day (United States of America)Job Exempt:
NoBenefits
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.
Physical Wellness:
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.
Emotional Wellness:
When life gets challenging employees have access to our Employee Assistance Program for employees and anyone in their household.
Financial Wellness:
Access the wages youve already earned before payday with Payactiv giving you greater flexibility over your finances.
Loan Reimbursement is available for this position dependent upon current degree level. Please discuss benefit with the recruiter.
Tuition Reimbursement is available to all employees to further develop skills and career.
We offer eligible employees up to 2% of eligible pay in 403(b) company-matching contributions plus another 2% in the 401(a) retirement income plan.
Three insurance plans are available to protect your family from the sudden loss of income in the event of your death terminal illness or serious injury from accident.
We offer both short-term and long-term disability insurance to replace a portion of your income if you become disabled and cannot work for a period of time.
Career Mobility:
Helping our employees develop their skills and grow their careers is critical to how we retain our talent and sustain our business. We do this by offering our teammates a variety of leadership-supported programs and learning and development resources for every stage of their professional development. We know that our employees are our most valuable resource they are how we grow our business and care for our community.
Equal Opportunity Employer M/F/Vet/Disability Assistive technologies are available. Application assistance for those requesting reasonable accommodation to the career site is available by contacting HR at .
Required Experience:
IC
Key Skills
About Company
MaineGeneral Health is a comprehensive non-profit system with the mission of enhancing, every day, the health of the people of the greater Kennebec Valley.
