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Utilization Review Rn Jobs in Maine (NOW HIRING)

TalentBurst, Inc.

Registered Nurse

Camden, ME · On-site

Reviews and revises plan of care as indicated; 3. Implementing Care: * Performs nursing functions ... Actively participates in Utilization Management or Interdisciplinary Care Management Meeting to ...

Rochester Regional Health

Applies utilization review criteria to assess and document appropriateness of admission ... Current licensure as an RN in the state of New York. PREFERRED QUALIFICATIONS: * Graduate of an ...

Coastal Manor

Registered Nurse RN

Yarmouth, ME · On-site

$44 - $51/hr

Registered Nurse RN Join our team at Coastal Manor in Yarmouth, Maine! At Coastal Manor, you'll ... Responsibilities: • Collaborate with a team to develop, implement, and review personalized care ...

Coastal Manor

Registered Nurse RN

Yarmouth, ME

$44 - $51/hr

Registered Nurse RN Join our team at Coastal Manor in Yarmouth, Maine! At Coastal Manor, you'll ... Responsibilities: • Collaborate with a team to develop, implement, and review personalized care ...

TalentBurst, Inc.

RN - Long Term Care

Camden, ME · On-site

Reviews and revises plan of care as indicated; 3. Implementing Care: * Performs nursing functions ... Actively participates in Utilization Management or Interdisciplinary Care Management Meeting to ...

Northern Light Health

Identifies opportunities to improve utilization of resources. Professional Development * Takes ... Actively participates in the peer review process. Performance Improvement * Demonstrates knowledge ...

Northern Light Health

Identifies opportunities to improve utilization of resources. Professional Development * Takes ... Actively participates in the peer review process. Performance Improvement * Demonstrates knowledge ...

Northern Light Health

Identifies opportunities to improve utilization of resources. Professional Development * Takes ... Actively participates in the peer review process. Performance Improvement * Demonstrates knowledge ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Maine

Utilization Review Rn information

See Maine salary details

$20

$40

$66

How much do utilization review rn jobs pay per hour?

As of Jul 6, 2026, the average hourly pay for 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.

How to get into utilization review as a nurse?

To become a utilization review RN, candidates typically need a valid nursing license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can enhance prospects, and familiarity with electronic health records and insurance policies is beneficial.

How does a Utilization Review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

What are the key skills and qualifications needed to thrive as a Utilization Review RN, and why are they important?

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

How to make $300,000 as a nurse?

A Utilization Review RN can earn $300,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-paying settings like insurance companies or managed care organizations, and taking on leadership or specialized roles that offer higher compensation. Advanced skills in clinical assessment, documentation, and understanding of healthcare policies can also contribute to higher earnings.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

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

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

How to make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-demand settings, and possibly taking on leadership or specialized roles. Increasing your workload, working overtime, or pursuing advanced education can also contribute to higher earnings within this field.

What is a Utilization Review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.
What are the most commonly searched types of Utilization Review Rn jobs in Maine? The most popular types of Utilization Review Rn jobs in Maine are:
What are popular job titles related to Utilization Review Rn jobs in Maine? For Utilization Review Rn jobs in Maine, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Maine look for? The top searched job categories for Utilization Review Rn jobs in Maine are:
What are popular job titles related to Utilization Review Rn jobs in ME? For Utilization Review Rn jobs in ME, the most frequently searched job titles are:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Maine as of July 2026, with employment types broken down into 25% Full Time, and 75% Contract. Highlights an 100% In-person job distribution, with an average salary of $85,150 per year, or $40.9 per hour.
Registered Nurse Clinical Manager

Registered Nurse Clinical Manager

CenterWell Primary Care

Portland, ME • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 22 days ago

CenterWell rating

9.0

Company rating: 9.0 out of 10

Based on 10 frontline employees who took The Breakroom Quiz

Job description

Become a part of our caring community
*$10,000 SIGN ON BONUS*
As a Clinical Manager at CenterWell Home Health, reporting to the Branch Director, you will lead and support a team of dedicated clinicians who deliver compassionate, highquality care in the home setting. By guiding clinical practice, coordinating patient services, and ensuring excellence in every step of the care journey, you'll empower patients to achieve their highest level of independence while helping your team thrive in their roles.

Work Schedule: Full-time/40 Hours

Position Type: On-site

Branch Location: Portland, ME

This is not a remote or work-from-home position. This position requires you to sit on-site at our Portland, ME branch location.

As a Registered Nurse Clinical Manager, you will:

  • Oversee clinical operations for the location, including patient care delivery, staff management, documentation quality, and regulatory compliance, working onsite in-office.
  • Review referrals, determine admission appropriateness, assign clinicians, and ensure Plans of Care meet patient needs and agency standards.
  • Guide, support, and educate clinicians; help goalset, care planning, and clinical decisionmaking; and remain available during operating hours for clinical support.
  • Ensure clinical documentation, audits, and billing meet Medicare, payer, and company standards; monitor case management quality and outcomes.
  • Participate in hiring, training, performance evaluation, coaching, and corrective action for clinical staff.
  • Conduct ongoing staff education based on documentation review, utilization review findings, and performance improvement data.
  • Coordinate communication among physicians, team members, and caregivers to support care coordination, discharge planning, and outcome achievement.
  • Participate in quality improvement, data tracking, budgeting activities, marketing initiatives, and community relationship development.
  • Provide direct patient care on a limited basis in exceptional or unplanned circumstances and act as Branch Director in their absence.
  • Perform additional tasks to support clinical operations and organizational goals.

Use your skills to make an impact
Required Experience/Skills:
  • Graduate of an accredited School of Nursing.
  • Current state license as a Registered Nurse.
  • Proof of current CPR.
  • Valid driver's license, auto insurance and reliable transportation.
  • Two years as a Registered Nurse with at least one-year of management experience.
  • Home health experience is preferred.
  • Management and people leadership experience, preferred.
  • OASIS experience, preferred. OASIS certification (HCS-O, COQS, and/or COS-C), preferred.
  • Homecare Homebase (HCHB) experience, preferred.
  • CMS PDGM billing knowledge and/or experience, preferred.

Additional Information

  • Normal Hours of Operation: M-F / 8a-5p (ET)
  • On-Call Expectation: Rotating on-call shift.
  • Branch Size: 258 Census (4.5 STAR rating)

Additional Information

TB Statement:

This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Driving Statement:

This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.


$77,200 - $106,200 per year


This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About Us
About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer atCenterWell.com.


Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

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