Temporary Registered Nurse- NO NIGHTS OR WEEKENDS!

Temporary Portland, Maine

• Location: Portland, Maine
• Type: Temporary
• Job #19875

Job Title: Utilization Review Nurse
Join one of our favorite clients in Portland as a remote Utilization Review Nurse! Immediate need! No weekends!
The Utilization Review Nurse plays a key role in evaluating medical services to ensure quality, cost-effectiveness, and appropriate care. Responsibilities include reviewing authorization requests, hospital admissions, and claims for medical necessity, as well as coordinating care transitions and discharge plans. The role involves collaboration with healthcare providers, compliance with regulations, and the use of clinical guidelines to support decision-making.

Key Responsibilities:

• Review and process authorizations and claims for medical necessity.
• Coordinate transitions of care and discharge planning.
• Ensure compliance with policies, guidelines, and regulatory requirements.
• Collaborate with internal teams and external healthcare providers.
• Participate in quality initiatives and maintain accurate documentation.

Qualifications:

• Current RN license; BSN preferred.
• 3+ years of clinical nursing experience, with utilization management experience preferred.
• Strong communication, critical thinking, and organizational skills.
• Proficiency in Microsoft Office

Additional Requirements:

• Certification in care management or managed care nursing (preferred).
• Participation in training, mentoring, and process improvement initiatives as needed.