Registered Nurse – Utilization Management - RNUMMK

NavitasPartners • Orono, ME

16h • $50 - $56

About The Position

We are currently seeking a qualified Registered Nurse (RN) with Utilization Management experience for a 14-week contract assignment in Orono, ME. The RN UM will be responsible for ensuring medical necessity, appropriate level of care, and regulatory compliance within a skilled nursing or post-acute care setting. The ideal candidate will have strong knowledge of Medicare, Medicaid, and managed care guidelines.

Responsibilities

• Review new and ongoing admissions for medical necessity and appropriate level of care.
• Verify insurance coverage and obtain required prior authorizations.
• Communicate with insurance providers regarding approvals, denials, and appeals.
• Monitor resident length of stay and evaluate continued skilled coverage eligibility.
• Coordinate Medicare, Medicaid, and managed care documentation requirements.
• Conduct concurrent reviews to support continued stay authorization.
• Track skilled nursing days and manage benefit periods accurately.
• Prepare and submit required clinical documentation to payers in a timely manner.
• Ensure compliance with CMS regulations and state guidelines.

What This Job Offers

• Career Level: Mid Level
• Education Level: No Education Listed