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

Job description

Job Summary: 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! Job Description: 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 What You'll Do: - 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 pre...