Utilization Manager RN - Care Management
About The Position
Central Maine Healthcare is seeking a Utilization Manager RN to join their Care Management team! This is a full time position on the day shift. Position Summary: The Utilization Management Nurse is responsible for a comprehensive clinical review to assess for medical necessity of outpatient and inpatient services, while maintaining compliance with all regulatory requirements. Work collaboratively with the Physician Advisor and Medicare Director of Care management in determining coverage of requested services; and in collaboration with other disciplines, provide planning and action for quality improvement.
Requirements
- Meets and maintains the minimum qualifications for the position including:
- Current State of Maine RN licensure.
- Three (3) or more years of previous experience in Utilization Management and/or Care Management.
- Certified Case manager required within 2 years of hire.
Nice To Haves
- BSN preferred
Responsibilities
- responsible for a comprehensive clinical review to assess for medical necessity of outpatient and inpatient services
- maintaining compliance with all regulatory requirements
- Work collaboratively with the Physician Advisor and Medicare Director of Care management in determining coverage of requested services
- in collaboration with other disciplines, provide planning and action for quality improvement
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
