Utilization Review RN

  • MaineHealth
  • Portland, ME, USA
  • Nov 24, 2022

Job Description


  • This is a bargaining unit position

  • Date posted 11/23/2022


  • For a limited time MaineHealth is offering up to $10,000 Sign on bonus for all eligible experienced Registered Nurses with 1-3 years of experience and $20,000 for experienced Registered Nurses with greater than 3 years of experience!

  1. Eligible candidates are hired (offer accepted) into a Full or Part time RN position. Bonus amount prorated for Part time hires, per diem hires are ineligible.
  2. Current MaineHealth member employees are ineligible; former MaineHealth Members are ineligible until greater than 6 months separation from employment.
  • ** Please note:  This position does not include discharge planning.   Previous Meg Surge, ER or Critical Care Experience required.  Experience as a Utilization Review RN highly preferred.  Experience with Inter-Qual and MCG criteria required.
  • Position Summary
    • The purpose of the Case Manager I position is to support the interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates utilization management, care facilitation and discharge planning functions. This work is performed under general supervision in accordance to the Maine Medical Center (MMC) institutional policies and Care Management Department policies.

      The Case Manager I is accountable for a designated patient caseload and plans effectively in order to meet patient needs, manage the length of stay, and promote efficient utilization of resources. Specific functions within this role include but are not limited to:

      • Facilitation of the collaborative management of patient care across the continuum, intervening as necessary to address barriers to timely and efficient care delivery, flow and reimbursement

      • Application of process improvement methodologies in evaluating outcomes of care

      • Support and coaching of clinical documentation efforts

      • Coordinating communication with the interdisciplinary care team Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the patient served.

      Must demonstrate knowledge of the principles of growth and development as it relates to the different life cycles.

  • Required Minimum Knowledge, Skills, and Abilities (KSAs)
    • Education: BSN or must matriculate into a BSN program within one year of hire and completion attained within 5 years of hire.
    • License/Certifications: Current and valid license to practice as a Registered Nurse in the state of Maine. Professional certification as a Case Manager preferred.
    • Experience: One to three years clinical experience in clinical practice area, three to five years preferred.
    • Excellent interpersonal communication and negotiation skills.
    • Strong analytical, data management and PC skills.
    • Working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement preferred.
    • Understanding of pre-acute and post-acute venues of care and post-acute community resources preferred.
    • Strong organizational and time management skills.
    • Ability to work independently and exercise sound judgment in interactions with interprofessional team, payors, and patients and their families.
    • Demonstrate commitment to organizational values.
    • Perform duties in a manner to promote quality patient care and customer service/satisfaction, while promoting safety, cost efficiency, and a commitment to the quality process.
Additional Information 

MaineHealth was ranked one of America’s Best Large Employers in 2022 by Forbes!

MaineHealth is a not-for-profit integrated health system whose vision is, “Working together so our communities are the healthiest in America.”  MaineHealth consists of nine local health systems, a comprehensive behavioral health care network, diagnostic services, home health agencies, and 1,700 employed clinicians working together through the MaineHealth Medical Group. With approximately 22,000 care team members, MaineHealth provides preventive care, diagnosis and treatment to 1.1 million residents in Maine and New Hampshire. Learn more about our system at mainehealth.org

At MaineHealth, we offer benefits that support an individual's needs for today and flexibility to plan for tomorrow. Our packages include health and dental insurances, paid parental leave, retirement program, generous paid time off, and much more! Our comprehensive array of benefits are competitive, affordable, and include choices that meet specific, but ever changing, needs.

With a career at any of the MaineHealth locations, you’ll be working with health care professionals that truly value the people around them – both within the walls of the organization and the neighborhoods that surround it. We are deeply invested in the well-being of our communities and care team members. We believe in fostering a work environment of strong commitment, compassionate caring and continuous improvement. Join us, and your abilities will be challenged and enhanced as you take your career to a new level.


Additional Information

Maine Medical Center is a Magnet designated 700-bed tertiary care and teaching institution. MMC is Maine's largest hospital and a state-wide health care resource. MMC offers outstanding career opportunities and quality of life in Portland.