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Remote Utilization Review Rn Jobs in Maine (NOW HIRING)

University of Rochester

$81K - $109K/yr

Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500009 Utilization Management ... Registered Nurse License, current in NYS upon hire required or NP - Nurse Practitioner license ...

Unum UK

LTC Wellness Manager

Portland, ME · On-site +1

Review claims history, intake information, engagement signals, and other available data to identify ... Licensure or certification in a clinical discipline (such as OT, RN, LCSW, or CCM) preferred, but ...

New

Guardian Recovery

THERAPIST

Portland, ME · On-site +1

$55K - $86K/yr

Registered Nurse certified as a Psychiatric Nurse, b. Advanced Practice Registered Nurse (APRN) ... C. 10:161A-1.9 employment, with progress towards certification or licensing on file, reviewed by ...

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Remote Utilization Review Rn information

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How much do remote utilization review rn jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for remote utilization review rn in Maine is $40.94, according to ZipRecruiter salary data. Most workers in this role earn between $32.36 and $47.02 per hour, depending on experience, location, and employer.

What is a remote utilization review RN?

A Remote Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients, typically working from a remote location. They review medical records, apply clinical guidelines, and collaborate with healthcare providers to ensure patients receive the right care at the right time. Their work helps manage healthcare costs and improves patient outcomes by preventing unnecessary treatments or hospital stays. Remote Utilization Review RNs often work for insurance companies, hospitals, or healthcare organizations, and use secure digital platforms to conduct their reviews.

What are the key skills and qualifications needed to thrive as a remote utilization review RN?

To excel as a Remote Utilization Review RN, you need a valid RN license, strong clinical judgment, and knowledge of utilization management principles. Familiarity with electronic medical records (EMR), utilization management software, and guidelines such as InterQual or MCG is typically required. Outstanding attention to detail, critical thinking, and effective communication skills help you collaborate with healthcare teams and advocate for appropriate patient care. These competencies are crucial for ensuring medical necessity, regulatory compliance, and optimal resource use in a remote setting.

What are some common challenges remote utilization review RNs face when working from home, and how can they be addressed?

Remote Utilization Review RNs often encounter challenges such as maintaining clear communication with interdisciplinary teams, managing time efficiently, and staying updated on changing payer guidelines. To address these challenges, it's important to establish consistent check-ins with team members via video or chat platforms, use digital tools to organize and prioritize caseloads, and participate in ongoing training sessions provided by employers. Adhering to a structured daily routine and leveraging available technology can help ensure productivity and high-quality reviews while working remotely.

What is the difference between Remote Utilization Review Rn vs Remote Case Manager Rn?

AspectRemote Utilization Review RnRemote Case Manager Rn
CertificationsRN license, Utilization Review certification (e.g., URAC)RN license, Case Management certification (e.g., CCM)
Work EnvironmentReviewing medical records, insurance policies, telehealth platformsCoordinating patient care, discharge planning, telehealth
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance providers, healthcare agencies

Remote Utilization Review Rns primarily focus on evaluating medical necessity for insurance coverage, while Remote Case Manager Rns coordinate patient care and discharge planning. Both roles require RN licensure and involve telehealth work, but they serve different functions within healthcare and insurance industries.

What are popular job titles related to Remote Utilization Review Rn jobs in Maine?

For Remote Utilization Review Rn jobs in Maine, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Rn jobs in Maine look for?

The top searched job categories for Remote Utilization Review Rn jobs in Maine are:

What cities in Maine are hiring for Remote Utilization Review Rn jobs?

Cities in Maine with the most Remote Utilization Review Rn job openings:

Remote Utilization Review Rn jobs near you
Infographic showing various Remote Utilization Review Rn job openings in Maine as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 13% Part Time, 3% Temporary, 2% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $85,150 per year, or $40.9 per hour.

Clinical Assurance Spec/RN

Northern Light Health

South Portland, ME • On-site, Remote

$32.65 - $50.11/hr

Full-time

Posted 7 days ago

Northern Light Health rating

6.6

Company rating: 6.6 out of 10

Based on 165 frontline employees who took The Breakroom Quiz

570th of 891 rated healthcare providers

Job description

The compensation range listed reflects the range Northern Light Health anticipates relying on in setting the wages for the position. The range may not necessarily include all additional compensation elements available, such as differentials, incentive programs and benefits.
Northern Light Home Care and Hospice
Department: Quality Management
Position is located: Northern Light South Portland
Work Type: Full Time
Hours Per Week: 40.00
Work Schedule: 8:00 AM to 5:00 PM
Salary Range : $32.65 - $50.11
Exempt: No
Summary:
The Clinical Assurance Specialist exercises independent judgement in analyzing clinical documentation to optimize accuracy with Oasis and other standardized assessment points, accurately establishing diagnoses codes to maximize reimbursement, and ensuring compliance with agency established standards of care, clinical orders and State and federal regulations. The Clinical Assurance Specialist collaborates with staff, Clinical and General Education leadership, and department leader to identify areas needing improvement at the staff and agency level regarding outcome and regulatory compliance. The Clinical Assurance Specialist assists with performing clinical audits and utilizing the unusual occurrence reporting system to document any pertinent findings. The incumbent exercises independent judgment in reviewing clinical documentation for accuracy and making corrections to the electronic health record as necessary. The Clinical Assurance Specialist timely processes all SOC/ROC, re-certification, and resumptions of care and discharge assessments. The Clinical Assurance Specialist tracks and documents OASIS inconsistencies and chart corrections. Provides reports to department leader on a timely basis. Provides patient care as needed.
Responsibilities:
  • Analyzes clinical documentation (including OASIS documentation) and diagnoses for accuracy while maximizing appropriate reimbursement for the organization
  • Utilizes critical thinking and organizing skills to ensure the timely processing of all SOC/ROC, re-certification, and resumptions of care and discharge assessments
  • Reviews OASIS for completeness and accuracy on admissions, re-certifications, resumptions of care and discharges and communicates needed changes to appropriate staff
  • Collaborates with others to review CMS additional documentation requests, monitor for trends and reports to clinical leaders
  • Problem solves and troubleshoots documentation for coding discrepancies, logical inconsistencies, errors, and completeness
  • Performs chart audits, assesses for trends, and communicates findings to clinical leaders
  • Makes corrections in electronic medical record as needed
  • Other Duties as assigned

Other Information:
  • Current license to practice as a Registered Nurse, Physical Therapist, Occupational Therapist or Speech Therapist in the State of Maine
  • BLS for Healthcare Providers certification is required to be obtained prior to independent visits.
  • Certification (or willing to get within 6 months of hire) as an OASIS Specialist-Clinical by the OASIS Certificate and Competency Board
  • Valid driver's license with reliable transportation and agency required auto liability insurance. Must be able to drive within assigned region as directed

Competencies and Skills
  • 2+ years of relative work experience required.• Two years of professional clinical experience, one of which is in home care
  • Achieves Results: Sets high standards for their own outcomes and seizes opportunities to engage others towards objectives. Consistently moves forward with direct actions in order to attain or exceed objectives. Manages their own time effectively to accomplish assigned tasks. Successfully prioritizes multiple projects and duties as needed.
  • Basic Life Support
  • Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one's behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.
  • Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.
  • Exercises Sound Judgment & Decision Making: Understands and processes complex information, which allows for appropriate and accountable conclusions. Does not react too quickly or slowly. Balances facts, goals, and potential approaches taking the appropriate criteria into account. Makes active decisions and commits oneself by communicating confidently and respectfully.
  • Human Capital, Supply Chain and Financial Software.
  • Ability to understand the language used to precisely describe the human body including its components, processes, conditions affecting it, and procedures performed upon it.
  • Word processing, spreadsheets, data entry, database experience and other computer related skills.
  • MS Teams
  • Multi-line phone, scanner, photocopier, fax, and internet.
  • Provides Patient-Centered Care: Demonstrates understanding of patient care quality and service as organizational priority. Proactively supports change to improve patient experience and results. Exhibits the ability and willingness to find out what the patient wants and needs and to act accordingly, taking the organizational and outside resources into account. Cooperates, collaborates, communicates, and integrates care within and between teams to ensure that care is continuous and reliable.
  • Zoom
  • Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
  • Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of belonging, empowerment, and cooperation.
  • Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
  • Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.

Credentials
  • Required Registered Nurse
  • Required Driver's License

Education
  • Required Bachelor's DegreeIn lieu of education, two years of experience is required per year of required education, exclusive of the minimum experience identified above

Working Conditions
  • Potential exposure to abusive and/or aggressive people.
  • Potential exposure to diseases or infections.
  • Need to drive to perform responsible duties.
  • Potential exposure to noxious odors.
  • Potential exposure to very hot or cold temperatures.
  • Work with computers, typing, reading or writing.
  • Work beyond the regularly scheduled hours.
  • Prolonged periods of sitting.
  • Lifting, moving and loading less than 20 pounds.
  • Lifting, moving and loading 20 to 30 pounds.

Questions? Contact Talent Acquisition:
phone: 207-973-7100
email: talentacquisition@northernlight.org
Maine, Aroostook County, Bangor, Waterville, Ellsworth, Presque Isle, South Portland, Home Care, Hospice Care, end of life, respite care, Home Health Aide, Skilled Nursing

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