Location: Orono, ME
Assignment Type: Contract
We are seeking an experienced Registered Nurse – Utilization Management (RN UM) to support utilization review and care coordination activities within a healthcare setting. This role focuses on ensuring appropriate use of healthcare services, compliance with regulatory requirements, and coordination of care across the continuum.
The RN UM will collaborate with physicians, care teams, and administrative staff to evaluate medical necessity, manage authorizations, and support quality and cost-effective patient care.
Key ResponsibilitiesConduct utilization review to ensure medical necessity and appropriate level of care
Review clinical documentation for compliance with payer, state, and federal guidelines
Coordinate prior authorizations, concurrent reviews, and discharge planning support
Collaborate with physicians and interdisciplinary teams regarding care plans and utilization decisions
Communicate with payers and internal departments regarding coverage determinations
Identify opportunities to improve care coordination and reduce avoidable utilization
Maintain accurate, timely, and compliant documentation in electronic systems
Participate in on-call rotation as required
Ensure compliance with facility policies, CMS, and accreditation standards
Shift: Day shift
Hours: Full-time
Guaranteed Hours: 40 per week
Contract Length: Approximately 14 weeks
On-Call: Required
Active Registered Nurse (RN) license in the practicing state
Prior experience in Utilization Management, Case Management, or Clinical Review
Strong knowledge of medical necessity criteria, utilization review processes, and payer guidelines
Experience with electronic medical records and utilization management systems
Excellent communication, critical thinking, and organizational skills
Ability to work independently and collaboratively within a multidisciplinary team
Experience in acute care, long-term care, or managed care settings
Familiarity with InterQual®, MCG®, or similar utilization review criteria
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