Utilization Review RN - Care Coordination & Reimbursement

MaineGeneral Medical Center; Augusta (ME); Presencial; USD 54.000 - 94.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, and vision insurance

Generous paid time off

Tuition assistance and professional发展

Descripción de la vacante

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

Formación

• 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.

Responsabilidades

• 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.

Conocimientos

RN license

Utilization Review

Care Management

Clinical assessment

Critical thinking

Communication

Team collaboration

Descripción del empleo

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