Maine Licensed Utilization Review Nurse

Job Summary

Maine Licensed Utilization Review Nurse, a full-time position responsible for reviewing prior authorization requests, managing medical necessity reviews, and coordinating care transitions while working a flexible schedule that includes Saturdays.

Key Responsibilities

• Review prior authorization requests and manage medical necessity reviews using evidence-based criteria
• Coordinate care transitions and establish discharge plans while collaborating with healthcare providers and team members
• Document reviews and decisions in compliance with regulatory guidelines and maintain productivity within department standards

Required Qualifications

• 3+ years of clinical nursing experience as an RN, preferably in a hospital setting
• Utilization management experience in a health plan UM department
• Compact RN License
• Certification in managed care nursing or care management desired (CMCN or CCM)
• Knowledge of regulatory guidelines and compliance requirements