Utilization Review Registered Nurse - 40 hours

MaineGeneral Medical Center; Augusta (ME); On-site; USD 54,000 - 94,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

Generous paid time off

Tuition assistance and professional发展

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 with a multidisciplinary team, we want to hear from you!

This role focuses on patient care coordination, utilization management, documentation, and reimbursement, with opportunities to impact length of stay and

Qualifications

• 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.

Responsibilities

• 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.

Skills

RN license

Utilization Review

Care Management

Clinical assessment

Critical thinking

Communication

Team collaboration

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.

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

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!

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

MaineGeneral is an equal opportunity employer. M/F/Vet/Disability. Assistive technologies are available. MaineGeneral participates in E-Verify.

Employee Rights

Employee Rights E-Verify Participation Equal Opportunity Employer M/F/Vet/Disability: In furtherance of MaineGeneral's policy regarding Equal Employment Opportunity, MaineGeneral has developed a written Aff…