Utilization Review Registered Nurse (RN) - 40 hrs/wk, Days

MaineGeneral Health•Augusta, ME

2d•Onsite

About The Position

MaineGeneral Health is seeking an experienced Utilization Review Registered Nurse (RN) to join our collaborative team. In this role, you will evaluate the medical necessity and appropriateness of patient care, ensuring alignment with clinical guidelines and payer requirements while supporting efficient, high-quality outcomes. If you have a passion for service excellence and enjoy working closely with interdisciplinary teams to optimize patient care and resource utilization, we want to hear from you! Position: Utilization Review Registered Nurse (RN) Location: Alfond Center for Health, Augusta Schedule: Full-time (40 hours/week) Shift: Days (8-4:30) Monday - Friday

Requirements

Active State of Maine Registered Nurse (RN) license, or ability to obtain promptly (required)
Strong critical thinking, communication, and organizational skills
Ability to work independently while collaborating effectively across teams

Nice To Haves

Prior experience in Utilization Review, Case Management, or Care Coordination (strongly 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 patients' 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.

Benefits

Flexible scheduling within a weekday-only schedule
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.
When life gets challenging, employees have access to our Employee Assistance Program for employees and anyone in their household.
Access the wages you’ve already earned before payday with Payactiv, giving you greater flexibility over your finances.
Loan Reimbursement is available for this position dependent upon current degree level.
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.
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.