What are the responsibilities and job description for the RN Utilization Management Nurse (UM Nurse) - 25-33957 position at NavitsPartners?
Job Title: RN Utilization Management Nurse (UM Nurse)
Duration: 14 Weeks Contract
Shift: Day Shift (7:00 AM – 3:30 PM)
Schedule: Monday – Friday (No weekends)
Location: Falmouth, ME
Job Description
We are seeking an experienced RN Utilization Management Nurse to support clinical review and care coordination activities at a skilled nursing/rehabilitation setting. The nurse will ensure that all resident care aligns with regulatory standards, payer requirements, and evidence-based practice guidelines.
Key Responsibilities
Conduct utilization reviews to ensure appropriate level of care and clinical necessity
Perform daily assessments, documentation reviews, and care coordination activities
Collaborate with interdisciplinary teams to support resident treatment plans
Monitor, track, and document authorizations, appeals, and clinical justifications
Ensure compliance with state, federal, and payer guidelines
Participate in case management meetings and provide UM recommendations
Maintain accurate and organized UM records and documentation
Communicate effectively with providers, therapists, and administrative staff
Requirements
Active and unencumbered Registered Nurse (RN) license
Prior experience in Utilization Management, Case Management, or Clinical Review
Strong knowledge of post-acute care, documentation standards, and clinical guidelines
Excellent communication, documentation, and analytical skills
Ability to work independently during weekday daytime schedule