Utilization Manager RN - Care Management

Prime Healthcare • Lewiston, ME

1d

About The Position

Overview Central Maine Healthcare is an integrated healthcare delivery system serving 400,000 people living in central, western and Midcoastal Maine. CMH's hospital facilities include Central Maine Medical Center in Lewiston, Bridgton Hospital and Rumford Hospital. CMH also supports Central Maine Medical Group, a primary and specialty care practice organization. Other system services include the Central Maine Heart and Vascular Institute, a regional trauma program, LifeFlight of Maine's southern Maine base, the Central Maine Comprehensive Cancer Center and other high-quality clinical services. Responsibilities Central Maine Healthcare is seeking a Utilization Manager RN to join their Care Management team! This is a full time position on the day shift. Position Summary: The Utilization Management Nurse is responsible for a comprehensive clinical review to assess for medical necessity of outpatient and inpatient services, while maintaining compliance with all regulatory requirements. Work collaboratively with the Physician Advisor and Medicare Director of Care management in determining coverage of requested services; and in collaboration with other disciplines, provide planning and action for quality improvement. Education and Experience: Meets and maintains the minimum qualifications for the position including: Current State of Maine RN licensure. Three (3) or more years of previous experience in Utilization Management and/or Care Management. BSN preferred Certified Case manager required within 2 years of hire. Employment Status Full Time Shift Days Equal Employment Opportunity Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Requirements

• Current State of Maine RN licensure.
• Three (3) or more years of previous experience in Utilization Management and/or Care Management.
• Certified Case manager required within 2 years of hire.

Nice To Haves

• BSN preferred

Responsibilities

• The Utilization Management Nurse is responsible for a comprehensive clinical review to assess for medical necessity of outpatient and inpatient services, while maintaining compliance with all regulatory requirements.
• Work collaboratively with the Physician Advisor and Medicare Director of Care management in determining coverage of requested services
• In collaboration with other disciplines, provide planning and action for quality improvement.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level