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Insurance Utilization Reviewer Jobs in Maine (NOW HIRING)

GQR Healthcare

Travel RN UM - $2,026 per week

Orono, ME · On-site

$2.0K/wk

Utilization Review * Discipline: RN * Start Date: 08/24/2026 * Duration: 12 weeks * 36 hours per ... Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License ...

American Traveler

Travel Care Manager

Portland, ME · On-site

Coordinate patient care management and utilization review activities * RTO should be kept to a ... life insurance beginning day one of your assignment, generous 401(k) match, substantial housing ...

Dane Street, LLC

Board-Certified Neurologist

Portland, ME · On-site

$327K - $409K/yr

... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...

Dane Street, LLC

Board-Certified Neurologist

Portland, ME

$327K - $409K/yr

... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...

Dane Street, LLC

Board-Certified Neurologist

Portland, ME · On-site

$327K - $409K/yr

... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...

Dane Street

Board-Certified Neurologist

Portland, ME · On-site

$332K - $415K/yr

... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...

UnitiMed

RN Case Manager

Biddeford, ME · On-site

Day 1 Insurance * * Cigna medical, MetLife dental and vision insurance * * License reimbursement ... Referral bonus up to $700 Registered Nurse (RN),Case Management/Utilization Review, About the ...

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Insurance Utilization Reviewer information

What are the key skills and qualifications needed to thrive as an insurance utilization reviewer, and why are they important?

To thrive as an Insurance Utilization Reviewer, you need a solid understanding of medical terminology, healthcare regulations, and insurance processes, usually supported by a clinical background or relevant certification. Familiarity with utilization review software, electronic health records (EHRs), and coding systems like ICD-10 and CPT is often required. Strong analytical thinking, attention to detail, and effective communication skills help reviewers assess medical necessity and coordinate with healthcare providers. These skills ensure accurate, efficient case evaluations and compliance with policies, which are crucial for optimizing patient care and managing healthcare costs.

What is the difference between Insurance Utilization Reviewer vs Insurance Claims Processor?

AspectInsurance Utilization ReviewerInsurance Claims Processor
Primary RoleReview medical necessity and appropriateness of services for insurance coverageProcess and review insurance claims for payment and accuracy
Required CredentialsOften requires healthcare or insurance certifications, such as RHIT or CPCTypically requires claims processing or insurance certifications, like CPC or CPC-H
Work EnvironmentHealthcare settings, insurance companies, or third-party administratorsInsurance companies, healthcare providers, or claims processing centers
Industry UsageCommonly employed in health insurance and managed careWidely used across health, auto, and property insurance sectors

The main difference is that Insurance Utilization Reviewers focus on evaluating the medical necessity of services, while Insurance Claims Processors handle the administrative processing of claims. Both roles require insurance-related certifications and are integral to the insurance industry, but they serve distinct functions in the claims and coverage review process.

What are some common challenges faced by insurance utilization reviewers, and how can they be addressed?

One of the primary challenges Insurance Utilization Reviewers face is balancing the need to adhere to strict insurance guidelines while advocating for appropriate patient care. Reviewers often handle high caseloads and must make timely decisions based on complex medical records, which requires strong attention to detail and up-to-date knowledge of coverage policies. Effective communication with healthcare providers and insurance representatives is also crucial to resolve discrepancies and ensure approvals. Staying organized, continuously updating clinical knowledge, and leveraging support from the utilization review team can help manage these challenges successfully.

What is an insurance utilization reviewer?

Insurance Utilization Reviewers are professionals who evaluate healthcare services to determine if they are medically necessary and covered by insurance policies. They review patient records, treatment plans, and insurance guidelines to ensure that the care provided aligns with established criteria and standards. Their work helps control healthcare costs, prevent unnecessary treatments, and ensure patients receive appropriate care. Utilization reviewers often communicate with healthcare providers and insurance companies to support or deny coverage decisions.

What are popular job titles related to Insurance Utilization Reviewer jobs in Maine?

For Insurance Utilization Reviewer jobs in Maine, the most frequently searched job titles are:

What job categories do people searching Insurance Utilization Reviewer jobs in Maine look for?

The top searched job categories for Insurance Utilization Reviewer jobs in Maine are:

Insurance Utilization Reviewer jobs near you

Travel RN UM - $2,026 per week

GQR Healthcare

Orono, ME • On-site

$2.0K/wk

Other

Medical, Dental, Vision

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

GQR Healthcare is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Orono, Maine.

Job Description & Requirements
  • Specialty: Utilization Review
  • Discipline: RN
  • Start Date: 08/24/2026
  • Duration: 12 weeks
  • 36 hours per week
  • Shift: 12 hours, days
  • Employment Type: Travel

Contract - W2 Nurse Manager Job
Location: Orono, Maine
Start Date: August 24, 2026
Profession:
Facility:
Estimated Pay: $2026.12 - $2121.12
Duration:12 weeks
Specialty:Nurse Manager
Shift: Day
Shift Details: null Day
Job Type: Travel
*Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates. Actual weekly pay and per diems may differ from the amount shown and are subject to change during an assignment.
Benefits:

  • Day 1 Insurance
  • Cigna medical, MetLife dental and vision insurance
  • License reimbursement for new licenses needed for each assignment
  • Discounts with hotels and rental cars
  • A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience
  • Referral bonus up to $700
About the Company:
Finding the right role is about more than just matching skills to a job—it’s about aligning with your goals, values, and the way you want to work.
As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. From our first conversation to your first day on the job (and beyond!), we’re here to help you move forward with confidence.

GQR Job ID #834873. Pay package is based on 12 hour shifts and 36 hours per week (subject to confirmation) with tax-free stipend amount to be determined.

About GQR Healthcare

GQR’s Healthcare team specializes in connecting experts within the industry to highly skilled healthcare professionals across the US market.

In the competitive healthcare market, we recognize that the industry’s common goals of improved quality of care and patient outcomes are wholly reliant upon the professionals directly supporting these initiatives. Leveraging our extensive candidate network, we deliver continuity of care for the communities our partners serve to ensure the patient experience is of the highest quality.

Through deep market specialization and a unique approach to talent acquisition, GQR Healthcare provides an unparalleled and personalized experience across all medical specialties in nursing and within diverse healthcare platforms across the industry.

GQR Healthcare logo

About GQR Healthcare

Sourced by ZipRecruiter

Leveraging our extensive candidate network, we deliver continuity of care for the communities our partners serve to ensure the patient experience is of the highest quality. Through deep market specialization and a unique approach to talent acquisition, GQR Healthcare provides an unparalleled and personalized experience across all medical specialties in nursing and within diverse healthcare platforms across the industry.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Austin, TX, US

Year founded

2019

Social media

Facebook

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