Utilization Review Registered Nurse - 40 hours

MaineGeneral Health System; Augusta (ME); On-site; USD 81,000 - 142,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

Generous paid time off

Retirement plan with employer contrib.

Tuition assistance and professional发展

Employee wellness programs

And more!

Job summary

MaineGeneral Health is seeking an experienced Utilization Review Registered Nurse (RN) to join our collaborative Utilization Review team. You’ll support appropriate patient care, navigate medical necessity and reimbursement, and work with a multidisciplinary team to coordinate care.

The role focuses on patient care coordination, utilization management, documentation, and reimbursement, with the chance to grow professionally in a supportive environment that values teamwork and continuous learning.

Qualifications

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

Responsibilities

• Reviews admissions and service requests for medical necessity and reimbursement criteria.
• Assists teams with issues related to medical records, pre-certifications, reimbursements and denials/appeals.
• Coordinates discharge planning needs with healthcare team.
• Monitors delays in care and prepares data to reduce length of stay and maximize reimbursement.

Skills

RN license

Utilization Review experience

Clinical assessment

Communication

Team collaboration

Independent work

Medical necessity knowledge

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.

Job Description:

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 MaineGeneral?

At MaineGeneral 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!

Compensation Information:

$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.

Scheduled Weekly Hours:

40

Job Exempt:

No

Benefits:

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 you’ve already earned before payday with Payactiv, giving you greater flexibility over your finances.

• 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’re 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 [phone] .