Utilization Review Nurse - Full-Time

About the role

This position is for an experienced Utilization Review Registered Nurse (RN) responsible for evaluating medical necessity, supporting patient care coordination, and ensuring compliance with reimbursement policies. The position supports career growth through leadership and learning opportunities, with a focus on collaboration and professional excellence.

Responsibilities

• Review admissions and service requests for prospective, concurrent, and retrospective medical necessity and reimbursement compliance.
• Assist multidisciplinary teams with documentation, pre-certifications, reimbursement issues, and claim denials/appeals.
• Collaborate on discharge planning and monitor delays in care to optimize length of stay and reimbursement.

Qualifications and Skills

• Current Maine RN license or ability to obtain one.
• Preferred experience in Utilization Review or Care Management.
• Strong clinical assessment, critical thinking, and decision-making skills.
• Excellent communication and teamwork abilities.
• Knowledge of medical necessity, reimbursement guidelines, and clinical documentation is advantageous.

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• Paid time off
• Retirement plans
• Professional development
• Wellness programs

Pay

Competitive hourly pay.