Utilization Manager RN - Care Management

Prime Healthcare • Lewiston, ME

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About The Position

Overview 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. Central Maine Healthcare is an integrated healthcare delivery system serving 400,000 people living in central, western and Midcoast Maine. CMH's hospital facilities include Central Maine Medical Center in Lewiston, Bridgton Hospital and Rumford Hospital. CMH also supports Central Maine Medical Group, a primary and specialty care practice organization. Other system services include the Central Maine Heart and Vascular Institute, a regional trauma program, LifeFlight of Maine's southern Maine base, the Central Maine Comprehensive Cancer Center and other high-quality clinical services. If you are passionate about making a difference and are looking for your next great career opportunity, we look forward to reviewing your application!

Requirements

• Current State of Maine RN licensure.
• Three (3) or more years of previous experience in Utilization Management and/or Care Management.

Nice To Haves

• BSN preferred
• Certified Case manager required within 2 years of hire.

Responsibilities

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed