RN Utilization Review Full-time
MaineGeneral Health

Utilization Review Registered Nurse (RN) - 40 hrs/wk, Days

MaineGeneral Health Augusta, ME 04330, US
Apply Now

Job Summary:

MaineGeneral Health is seeking an experienced Utilization Review Registered Nurse (RN) to join our collaborative team. In this role, you will evaluate the medical necessity and appropriateness of patient care, ensuring alignment with clinical guidelines and payer requirements while supporting efficient, high-quality outcomes. If you have a passion for service excellence and enjoy working closely with interdisciplinary teams to optimize patient care and resource utilization, we want to hear from you!

Job Description:

Position: Utilization Review Registered Nurse (RN)

Location: Alfond Center for Health, Augusta
Schedule: Full-time (40 hours/week)

Shift:  Days (8-4:30) Monday - Friday

What You'll Do:

  • Reviews admissions and service requests within assigned unit for prospective, concurrent, and retrospective medical necessity and/or compliance with reimbursement policy criteria.
  • Assists multidisciplinary teams with issues related to medical records/documentation, pre-certifications, reimbursement, and claim denials/appeals.
  • Collaborates to assess and coordinate patients' discharge planning needs with members of the healthcare team.
  • Monitors for delays in care and prepares data to reduce length of stay and maximize reimbursement.

What You Bring:

  • Active State of Maine Registered Nurse (RN) license, or ability to obtain promptly (required)
  • Prior experience in Utilization Review, Case Management, or Care Coordination (strongly preferred)
  • Strong critical thinking, communication, and organizational skills
  • Ability to work independently while collaborating effectively across teams

Why Join MaineGeneral Health:

  • Collaborative, team-focused work environment
  • Meaningful impact on patient outcomes and care efficiency
  • Flexible scheduling within a weekday-only schedule
  • A health system committed to excellence, compassion, and community

Scheduled Weekly Hours:

40

Scheduled Work Shift:

Day (United States of America)

Job Exempt:

No

Benefits

Supporting all aspects of our employees’ wellness – physical, emotional and financial – is a critical component of being a great place to work. With the wide range of benefits and programs available, employees have the resources they need to be well at every stage of life and plan for the future.

Physical Wellness:

  • We offer quality health, dental, and vision benefits and wellness programs and resources to provide employees access to resources for a healthy lifestyle and help manage health care costs.

  • Employees have access to industry-leading leave for new parents.

  • A generous earned time plan is offered to all employees - We believe employees need and deserve time away from work to observe holidays, be with family, go on vacation, or simply take care of themselves.

Emotional Wellness:

When life gets challenging, employees have access to our Employee Assistance Program for employees and anyone in their household.

Financial Wellness:

  • Access the wages you’ve already earned before payday with Payactiv, giving you greater flexibility over your finances.

  • Loan Reimbursement is available for this position dependent upon current degree level.  Please discuss benefit with the recruiter.

  • Tuition Reimbursement is available to all employees to further develop skills and career.

  • We offer eligible employees up to 2% of eligible pay in 403(b) company-matching contributions plus another 2% in the 401(a) retirement income plan.

  • Three insurance plans are available to protect your family from the sudden loss of income in the event of your death, terminal illness or serious injury from accident.

  • We offer both short-term and long-term disability insurance to replace a portion of your income if you become disabled and cannot work for a period of time.

Career Mobility:
Helping our employees develop their skills and grow their careers is critical to how we retain our talent and sustain our business. We do this by offering our teammates a variety of leadership-supported programs and learning and development resources for every stage of their professional development. We know that our employees are our most valuable resource they are how we grow our business and care for our community.

Equal Opportunity Employer M/F/Vet/Disability  Assistive technologies are available. Application assistance for those requesting reasonable accommodation to the career site is available by contacting HR at (207) 861-3440 .

Share this job

Share to FB Share to LinkedIn Share to Twitter

Related Jobs

RN Med-Surg Other
MaineHealth

Registered Nurse (RN)- Medical/Surgical

MaineHealth Damariscotta, ME
Description Lincoln Hospital Nursing Req #: 66263 This is a Registered Nurse 2 vacancy open to candidates with greater than 1 year of RN work experience For a limited time MaineHealth is offering a $10,000 Sign on bonus for all eligible Registered Nurses with 0-2 years of RN experience and $20,000 for Registered Nurses with greater than 2 years of RN work experience! 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. Current MaineHealth member employees are ineligible; former MaineHealth Members are ineligible until greater than 6 months separation from employment. Summary The Medical Surgical Department is an 18-bed unit where nurses provide care for individuals across the life span (pediatrics – geriatrics) who are experiencing illness and accident that is appropriately cared for in an acute community hospital setting. This includes stroke, telemetry, orthopedics, medical issues,palliative care, and hospice. The Registered Nurse - Acute Care role provides high quality patient care through assessment, planning, implementation, and evaluation of patient outcomes. Collaborates, delegates, and communicates with members of the healthcare team to ensure optimal care. Required Minimum Knowledge, Skills, And Abilities (KSAs) Education: Graduate of an accredited School of Nursing required; BSN preferred. Licensure/Certification: Current applicable state(s) license as a Registered Professional Nurse required. Current BLS certification required or must obtain within 30 days of start date. ICU, SCU, ED and PACU RN’s require ACLS and PALS Certifications within one year of start date or in accordance with Department guidelines. OB, NICU RN’s require NRP Certification within one year of start date or in accordance with Department guidelines. Experience: One year of recent RN experience preferred. Additional Skills/Requirements Required: Annual Electronic Fetal Monitoring competency for any RN assisting Laboring Women required. Additional Skills/Requirements Preferred: N/A Hiring Scam Alert MaineHealth will never request financial information during the interview or pre-hiring process. All legitimate communications will come from an email address ending in @mainehealth.org. If you suspect fraudulent activity, please report it immediately to mhcareers@mainehealth.org. Additional Information With a career at any of the MaineHealth locations across Maine and New Hampshire, you’ll be working with health care professionals that truly value the people around them – both within the walls of the organization and the communities that surround it. We offer benefits that support an individual's needs for today and flexibility to plan for tomorrow – programs such as paid parental leave, a flexible work policy, student loan assistance, training and education, along with well-being resources for you and your family. MaineHealth remains focused on investing in our care team and developing an inclusive environment where you can thrive and feel supported to realize your full potential. If you’re looking to build a career in a place where people help one another deliver best-in-class care, apply today. If you have questions about this role, please contact lisa.bickford@mainehealth.org
RN Other
MaineHealth

Registered Nurse (RN)- Coves Edge

MaineHealth Damariscotta, ME
Description Cove’s Edge Nursing Req #: 67699 * Per diem* About Coves Edge Cove’s Edge has provided skilled rehabilitation services and long-term care since 1981.Our friendly atmosphere, warm and caring staff, and wide range of innovative services ensure each patient or resident gets the very best care possible.Our mission is to provide the appropriate level of care, as it is needed, in a skilled, safe, and compassionate environment. Summary The Registered Nurse - Ambulatory Care role provides high quality care to patients and families calling or presenting for care through assessment, planning, implementation, and evaluation, and performs a wide variety of patient care services to assist physicians/advanced practice practitioners in delivering excellent care to patients of the practice. Required Minimum Knowledge, Skills, And Abilities (KSAs) Education: Graduate of an accredited School of Nursing required; BSN preferred. License/Certifications: Current applicable state(s) license as a Registered Professional Nurse required. Current BLS certification required or must obtain within 30 days of start date. Fully remote care team members exempt from BLS certification requirement. Experience: One year of RN experience preferred. Additional Skills/Requirements Required: N/A Additional Skills/Requirements Preferred: N/A Hiring Scam Alert MaineHealth will never request financial information during the interview or pre-hiring process. All legitimate communications will come from an email address ending in @mainehealth.org. If you suspect fraudulent activity, please report it immediately to mhcareers@mainehealth.org. Additional Information With a career at any of the MaineHealth locations across Maine and New Hampshire, you’ll be working with health care professionals that truly value the people around them – both within the walls of the organization and the communities that surround it. We offer benefits that support an individual's needs for today and flexibility to plan for tomorrow – programs such as paid parental leave, a flexible work policy, student loan assistance, training and education, along with well-being resources for you and your family. MaineHealth remains focused on investing in our care team and developing an inclusive environment where you can thrive and feel supported to realize your full potential. If you’re looking to build a career in a place where people help one another deliver best-in-class care, apply today. If you have questions about this role, please contact lisa.bickford@mainehealth.org
RN Other
MaineHealth

Registered Nurse (RN)- Coves Edge

MaineHealth Damariscotta, ME
Description Cove’s Edge Nursing Req #: 64046 For a limited time MaineHealth is offering a $10,000 Sign on bonus for all eligible Registered Nurses with 0-2 years of RN experience and $20,000 for Registered Nurses with greater than 2 years of RN work experience! 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. Current MaineHealth member employees are ineligible; former MaineHealth Members are ineligible until greater than 6 months separation from employment. This is a part-time evening shift position, scheduled for 24 hours per week. The Registered Nurse at Cove's Edge provides high quality care to patients and families calling or presenting for care through assessment, planning, implementation, and evaluation, and performs a wide variety of patient care services to assist physicians/advanced practice practitioners in delivering excellent care to patients of the practice. Required Minimum Knowledge, Skills, And Abilities (KSAs) Education: Graduate of an accredited School of Nursing required; BSN preferred. License/Certifications: Current applicable state(s) license as a Registered Professional Nurse required. Current BLS certification required or must obtain within 30 days of start date. Fully remote care team members exempt from BLS certification requirement. Experience: One year of RN experience preferred. Additional Skills/Requirements Required: N/A Additional Skills/Requirements Preferred: N/A Hiring Scam Alert MaineHealth will never request financial information during the interview or pre-hiring process. All legitimate communications will come from an email address ending in @mainehealth.org If you suspect fraudulent activity, please report it immediately to mhcareers@mainehealth.org Additional Information With a career at any of the MaineHealth locations across Maine and New Hampshire, you’ll be working with health care professionals that truly value the people around them – both within the walls of the organization and the communities that surround it. We offer benefits that support an individual's needs for today and flexibility to plan for tomorrow – programs such as paid parental leave, a flexible work policy, student loan assistance, training and education, along with well-being resources for you and your family. MaineHealth remains focused on investing in our care team and developing an inclusive environment where you can thrive and feel supported to realize your full potential. If you’re looking to build a career in a place where people help one another deliver best-in-class care, apply today. If you have questions about this role, please contact lisa.bickford@mainehealth.org
RN Outpatient Other
MaineHealth

Registered Nurse (RN) - Primary Care Damariscotta

MaineHealth Damariscotta, ME
Description MaineHealth Medical Group Practice Req.#69842 This is a Registered Nurse 2 vacancy open to candidates with greater than 1 year of RN work experience. For a limited time, MaineHealth is offering up to$10,000 Sign-on bonus for all eligibleRegistered Nurses with 0-2years of experience and $20,000 for experienced Registered Nurses with greater than 2years of experience! 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. Current MaineHealth member employees are ineligible; former MaineHealth Members are ineligible until greater than 6 months separation from employment. MaineHealth Primary Care Damariscottais seeking a full time Registered Nurse - Ambulatory Care role provides high quality care to patients and families calling or presenting for care through assessment, planning, implementation, and evaluation, and performs a wide variety of patient care services to assist physicians/advanced practice practitioners in delivering excellent care to patients of the practice. MH RN II: This level is competent in their clinical role and has demonstrated the ability to care for most patients assigned. Though not able to care for every patient type within their area of hire, demonstrates how to obtain the appropriate resources to develop required skills and knowledge over time. This level included automatic advancement after 1 year as a RN I – must be in good standing and meets RN I requirements. Required Minimum Knowledge, Skills, And Abilities (KSAs) Education: Graduate of an accredited School of Nursing required; BSN preferred. License/Certifications: Current applicable state(s) license as a Registered Professional Nurse required. Current BLS certification required or must obtain within 30 days of start date. Experience: One year of recent RN experience required. Automatic advancement from RN I level if all onboarding requirements are complete, including the New Grad Residency (where available). Hiring Scam Alert MaineHealth will never request financial information during the interview or pre-hiring process. All legitimate communications will come from an email address ending in @mainehealth.org. If you suspect fraudulent activity, please report it immediately to mhcareers@mainehealth.org. Additional Information With a career at any of the MaineHealth locations across Maine and New Hampshire, you’ll be working with health care professionals that truly value the people around them – both within the walls of the organization and the communities that surround it. We offer benefits that support an individual's needs for today and flexibility to plan for tomorrow – programs such as paid parental leave, a flexible work policy, student loan assistance, training and education, along with well-being resources for you and your family. MaineHealth remains focused on investing in our care team and developing an inclusive environment where you can thrive and feel supported to realize your full potential. If you’re looking to build a career in a place where people help one another deliver best-in-class care, apply today. If you have questions about this role, please contact kaye.cross@mainehealth.org
RN CNO Director of Nursing Other
MaineHealth

Senior Director - Associate Chief Nursing Officer (ACNO)

MaineHealth Damariscotta, ME
Description Lincoln Hospital Management/Leadership Req #: 73105 Summary The Senior Director - Associate Chief Nursing Officer (ACNO) partners closely with the Regional CNO to define the strategic vision for nursing services and lead the execution and evaluation of key initiatives. This role shares responsibility for delivering exceptional, patient-centered care and provides direct oversight of designated nursing areas at Lincoln Hospital. As a trusted nurse leader, the ACNO champions leadership development within the nursing team and serves as a delegate for the CNO when needed, exercising broad decision-making authority, managing administrative on-call responsibilities, and representing nursing services on the executive leadership team. This position is considered a key succession role for the Chief Nursing Officer and offers an opportunity to influence organizational strategy while advancing nursing excellence. offers an opportunity to influence organizational strategy while advancing nursing excellence Required Minimum Knowledge, Skills, And Abilities (KSAs) Education:Master’s degree in nursing or other related field required. License/Certifications: Current licensure as a registered nurse in the state of Maine. Experience: Five years of progressive nurse leadership experience required, providing a thorough understanding of hospital and nursing standards and procedures, as well as applicable state, federal, and regulatory agency requirements. Additional Skills/Requirements Required: N/A Additional Skills/Requirements Preferred: N/A Hiring Scam Alert MaineHealth will never request financial information during the interview or pre-hiring process. All legitimate communications will come from an email address ending in @mainehealth.org. If you suspect fraudulent activity, please report it immediately to mhcareers@mainehealth.org. Additional Information With a career at any of the MaineHealth locations across Maine and New Hampshire, you’ll be working with health care professionals that truly value the people around them – both within the walls of the organization and the communities that surround it. We offer benefits that support an individual's needs for today and flexibility to plan for tomorrow – programs such as paid parental leave, a flexible work policy, student loan assistance, training and education, along with well-being resources for you and your family. MaineHealth remains focused on investing in our care team and developing an inclusive environment where you can thrive and feel supported to realize your full potential. If you’re looking to build a career in a place where people help one another deliver best-in-class care, apply today. If you have questions about this role, please contact jennifer.kopp@mainehealth.org