Registered Nurse – Utilization Management - RNUMMK

NavitasPartners • Camden, ME

1d • $50 - $56

About The Position

We are seeking an experienced Registered Nurse (RN) with Utilization Management expertise for a 14-week contract assignment in Camden, ME. The RN UM will be responsible for reviewing admissions, ensuring medical necessity, coordinating payer communications, and maintaining compliance with CMS and state regulations within a skilled nursing or post-acute care setting.

Requirements

• Active Registered Nurse (RN) license.
• Current BLS (Basic Life Support) certification.
• Experience in Utilization Management, Case Management, or Skilled Nursing review processes preferred.
• Strong knowledge of Medicare, Medicaid, and managed care regulations.

Responsibilities

• Review patient admissions to determine medical necessity and appropriate level of care.
• Verify insurance coverage and obtain required prior authorizations.
• Communicate with insurance providers regarding approvals, denials, and appeals.
• Monitor resident length of stay and evaluate ongoing skilled coverage eligibility.
• Coordinate Medicare, Medicaid, and managed care documentation requirements.
• Conduct concurrent reviews to support continued stay justification.
• Track skilled nursing days and benefit periods accurately.
• Prepare and submit required clinical documentation to payers.
• Ensure compliance with CMS guidelines and state regulatory standards.

What This Job Offers

• Education Level: No Education Listed