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Utilization Case Manager Jobs in Maine (NOW HIRING)

Sauk Prairie Healthcare

$22 - $28.75/hr

None POSITION SUMMARY The Case Manager-Social Worker coordinates and facilitates patient care activities to promote optimum and appropriate utilization of resources, improve continuity of care across ...

UnitiMed

RN Case Manager

Biddeford, ME · On-site

Referral bonus up to $700 Registered Nurse (RN),Case Management/Utilization Review, About the Company: Uniti Med is an award-winning healthcare staffing company with a mission to provide staffing ...

UnitiMed

RN Case Manager

Portland, ME · On-site

Referral bonus up to $700 Registered Nurse (RN),Case Management/Utilization Review, About the Company: Uniti Med is an award-winning healthcare staffing company with a mission to provide staffing ...

UnitedHealth Group

Case Manager RN

Bangor, ME · On-site

$60K - $107K/yr

Maintains a working knowledge of care management, care coordination changes, utilization review ... Case management experience * ACM, CCM or other certification applicable to utilization management

UnitedHealth Group

Case Manager RN

Bangor, ME

$60K - $107K/yr

Maintains a working knowledge of care management, care coordination changes, utilization review ... Case management experience * ACM, CCM or other certification applicable to utilization management

UnitedHealth Group

Case Manager RN

Bangor, ME · On-site

$60K - $107K/yr

Maintains a working knowledge of care management, care coordination changes, utilization review ... Case management experience * ACM, CCM or other certification applicable to utilization management

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All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Maine

Utilization Case Manager information

What is a utilization case manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

What are the key skills and qualifications needed to thrive as a utilization case manager?

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

How does a utilization case manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

What is the difference between Utilization Case Manager vs Utilization Review Nurse?

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

What degree do I need for utilization case manager?

Utilization case managers typically need at least a bachelor's degree in healthcare, social work, nursing, or a related field. Some positions may prefer or require a master's degree or relevant certifications, such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ).

What are popular job titles related to Utilization Case Manager jobs in Maine?

For Utilization Case Manager jobs in Maine, the most frequently searched job titles are:

What job categories do people searching Utilization Case Manager jobs in Maine look for?

The top searched job categories for Utilization Case Manager jobs in Maine are:

What cities in Maine are hiring for Utilization Case Manager jobs?

Cities in Maine with the most Utilization Case Manager job openings:

Utilization Case Manager jobs near you

RN - Case Management

IU Health Methodist University

Biddeford, ME • On-site

$2.3K/wk

Other

Medical, Dental, Vision, Life, Retirement

Posted 10 days ago

Job description

Details
Client Name
Southern Maine Health Care - Biddeford
Job Type
Travel
Offering
Nursing
Profession
RN
Specialty
Case Management
Job ID
37075396
Job Title
RN - Case Management
Weekly Pay
$2337.31
Shift Details
Shift
8 Hour Day
Scheduled Hours
40
Job Order Details
Start Date
05/11/2026
End Date
08/09/2026
Duration
13 Week(s)
Job Description
Registered Nurse Case Manager
Assignment Duration
This is a 13-week contract position.
Schedule
Shift: 7:30 AM - 4:00 PM, with every third weekend from 7:30 AM - 4:00 PM.
Job Description
We are seeking an experienced Registered Nurse Case Manager to focus on Care Coordination and Discharge Planning, in addition to Utilization Review. The ideal candidate will possess strong clinical experience and have a proven track record in Case Management.
Responsibilities
  • Coordinate patient care and discharge planning.
  • Conduct Utilization Review activities.
  • Manage a caseload effectively to ensure efficiency in length of stay management.
  • Collaborate with interdisciplinary teams for comprehensive patient care.
Required Experience / Certifications / Licensure
  • Current RN licensure with 4-5 years of nursing experience.
  • Minimum of 3 years of acute clinical experience.
  • Experience in Case Management, with at least 2-3 prior travel assignments.
  • Not suitable for candidates on their first travel assignment.
Why ARMStaffing?
At ARMStaffing, we take care of our employees! We offer:
  • Health Benefits: Medical, Dental, Vision, Life, and more
  • Onboarding Made Easy: We handle physicals, titers, and more so you can focus on care
  • Clinical Support: In-house clinical team available to assist and advocate
  • 401k Retirement Plan: Eligible after waiting period; 4% match with 5% contribution
  • Recruiter Matching: Get paired with a recruiter based on your location and specialty
  • Extras: Travel reimbursement, housing allowance, meals, referral bonuses, and more
We're not the only ones who think ARMStaffing should be your first choice. Here's why:
  • SIA's Top-50 Fastest Growing Healthcare Staffing Firms - 2019
  • SIA's Largest Healthcare Staffing Agencies in the U.S. - 2023
  • Top Workplace in the Lehigh Valley - 2022, 2023
  • Perfect scores for 'Name, Not a Number' and 'Recruiters' Personalities' on Highway Hypodermics
  • We've earned The Joint Commission's Gold Seal of Approval for healthcare staffing 15 years strong and counting!

Contract & local rates may vary based on location and applicant residency. Ask your ARMStaffing recruiter for details!
Client Details
Address
1 Medical Center Drive
City
Biddeford
State
ME
Zip Code
04005
Job Board Disclaimer
Job listings are updated in real time and may change or close without notice. Availability isn't guaranteed, and all placements require completed credentials and onboarding.

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