Job Title: Registered Nurse – Utilization Management (RN UM) | Day Shift | Travel Contract
Location: Falmouth, ME
Start Date: ASAP
Contract Length: 14 Weeks (with possible extension0
Shift: Day Shift (7:00 AM – 3:30 PM)
Schedule: Monday to Friday (40 hours/week guaranteed)
Employment Type: Contract (Travel or Local RN accepted)
Order Type: New Opening
Job Description:
We're seeking a knowledgeable and detail-oriented Registered Nurse – Utilization Management (RN UM) for a 14-week daytime travel contract. The ideal candidate will possess strong leadership skills and a comprehensive understanding of nursing practices, particularly in a nursing home or ICU setting. The Nursing Supervisor will be responsible for ensuring high-quality patient care, managing team performance, and facilitating effective communication among staff members. This is a fantastic opportunity for a nurse who is experienced in utilization review and care coordination within a skilled nursing or long-term care environment.
Key Responsibilities:
- Perform utilization management and review functions to ensure appropriate care levels and resource use.
- Evaluate medical necessity and level of care based on clinical criteria and payer guidelines.
- Collaborate with interdisciplinary teams to coordinate care and optimize patient outcomes.
- Maintain timely and accurate documentation for authorizations, approvals, and denials.
- Communicate with insurance providers and case managers regarding clinical updates and coverage needs.
- Monitor trends in utilization and escalate concerns as needed.
- Ensure compliance with all facility, state, and federal regulations.
Requirements:
- Active RN license in Maine or compact state.
- Minimum of 2 years of recent experience in Utilization Management or Case Management.
- Strong understanding of medical necessity criteria (e.g., InterQual, MCG).
- Excellent communication, assessment, and organizational skills.
- Experience working in long-term care or skilled nursing facilities preferred.
- Proficiency in EMR and care coordination software systems.
Benefits:
- 40 hours/week guaranteed
- Stable Monday–Friday daytime schedule
- Supportive team environment
- Travel-friendly assignment
Duties
- Supervise and coordinate nursing staff activities to ensure optimal patient care.
- Conduct diagnostic evaluations and monitor vital signs to assess patient health.
- Oversee utilization review processes to ensure appropriate patient care plans.
- Manage case management procedures, ensuring effective treatment and follow-up.
- Provide training and support to nursing staff in primary care practices.
- Facilitate team management by fostering a collaborative work environment.
- Ensure compliance with healthcare regulations and facility policies.
- Assist with patient care as needed, including lifting and ventilating patients when required.
Experience
- Previous experience in a nursing home or ICU setting is preferred.
- Proven track record of team management and leadership within a healthcare environment.
- Familiarity with vital signs monitoring and diagnostic evaluation techniques.
- Experience in utilization review and case management is highly desirable.
- Strong communication skills to effectively interact with patients, families, and staff members.