Utilization Review Nurse (Remote)

About the Role

Join Martin's Point Health Care as a Utilization Review Nurse working remotely in Maine. This role focuses on reviewing inpatient and outpatient prior authorization requests to ensure high-quality, cost-efficient medical outcomes.

Key Responsibilities

• Review prior authorization requests for medical necessity.
• Coordinate transitions of care and discharge planning.
• Manage medical claims disputes and collaborate with healthcare providers.
• Participate in quality initiatives and maintain documentation.
• Provide weekend coverage on a rotating basis.

Requirements

• Associate's degree in nursing required; Bachelor's preferred.
• Compact RN license.
• 3+ years clinical nursing experience, preferably hospital setting.
• 2+ years utilization management experience.
• Certification in managed care nursing preferred.

Benefits & Compensation

• Comprehensive health, dental, and vision insurance.
• Full benefits package.

Work Schedule

• Full-time employment.
• Weekend coverage required on rotation.
• Call requirements not explicitly stated.
• Night shift requirements not mentioned.

This position is fully remote, allowing you to work from home while contributing to a mission-driven organization committed to transforming healthcare.