Utilization Review Rn Jobs in Maine (NOW HIRING)

Northern Light Eastern Maine Medical Center Bangor, ME
Department: Primary Care - EMMC
Position is located: 925 Union Street
Work Type: Full Time
Hours Per Week: 40.00
Work Schedule: Variable
Sign On Bonus Available
Summary:
The Residency RN will be responsible for the assessment, triage of patient needs and collaborating with a multidisciplinary team. The Residency RN will need to act a not only as a patient advocate and liaison but must also operate with the understanding that they are working with inexperienced providers and that patient safety is of the utmost priority. RN will need to be actively supportive of the residents and their education.
Responsibilities:
PEOPLE • Is a complementary member of the health care team. • Demonstrates professionalism as well as respect, honesty, dignity, and caring behaviors for the patient/family and all members of the health care team. • Demonstrates excellent interpersonal and communication skills patients and faculty and residents • Assist with educating residents to services and systems in regard to clinical decisions within the nursing scope of practice • Collegially collaborate with resident in regards to assisting their education of physician practice system. • Demonstrates the ability to manage conflict. • Maintain a broad knowledge base of primary care and the primary care system to assist as a resource to all providers including residents. • Collaborates with members of the health care team and the patient/family. • Effectively facilitates communication between the physician and others in order to achieve established goals for the patient. • Communicates decision related to clinical and operational roadblocks to patient/family, physicians and members of the healthcare team. • Screens referrals from providers on complex situations that may require outside resource intervention. • Demonstrates the ability to develop relationships across organization lines using interpersonal communication skills. SERVICE • Responds to all patient calls, walk-in's that require triage. • Available to providers, clinical and clerical staff to assess any unstable patient needs. • Collects, reviews and documents patients' current health status and history according to standard. • Counsels patients to care for or cope with his/her condition. Provides instruction for self-care management of acute or chronic medical conditions. • Provide effective assessment of patient's needs, identifying and addressing needs as indicated • Updates, implements and evaluates interventions according to policy, procedure and current JPP.• Provides appropriate and effective patient education, as indicated. • Assists patients/families to understand and comply with their established plan of care. • Accepts telephone orders within scope of practice or delegates when appropriate, and documents and reads back the order. • Demonstrates dedication to the pursuit of excellence in improving the health care of the patient.• Assessment of patient/family needs:• Conducts assessments of the assigned population. Assessing the patient's needs to include but not limited to: • Educational needs • Level of ability to manage their care • Barriers to care • Need for additional services • Initiates care management referrals for patients meeting care management criteria as indicated. • Collaborative manage Level 1 Case management patients with the Physician Practice Case Management Department • Manages assigned case load, assessing utilization of resources and services; identifying all patient that require additional management to promote quality care and cost containment. • Demonstrates the ability to collaborate with providers, practice health care team members and other health care team members outside of the practice while making decisions to care manage the assigned patient population. • Demonstrates the ability to organize and carry out duties without direct supervision. • Demonstrates the ability to problem-solve using clinical and critical thinking skills. • Demonstrates the ability to identify the community needs of the patient and refer as indicated. • Seeks and maintains knowledge of community services/resources, support programs, different levels of care services, to include but not limited to home health services, long-term care, skilled level of care, free/reduced drug programs, and state and federal programs. • Seeks and maintains knowledge of payer requirements, developing a collaborative working relationship with third party payers as needed. • Manage Anticoagulation Patients using the EMMC Primary Care Warfarin Adjustment Policy • Assume other duties and responsibilities as assigned QUALITY • 100% compliance of iCARE, (complete annually at least seven days prior to evaluation) • Assists in the provision of timely health care delivery to achieve optimal quality and financial outcomes. • Provides ongoing utilization review of primary care patients. Review for over utilization of medical services and alternatives to this utilization that may be more cost effective. • Adheres to established organization policies and procedures to include but not limited to HIPAA regulations, Code of Conduct etc., as per EMMC IDD/PCD policies. • Performs all duties and responsibilities in accordance with the Nurse Practice Act and in accordance with the basic principles and guidelines of professional nursing. • Reports variance from expected outcomes and communicates changes in patient's conditions to the provider in a timely manner. • Effectively communicate patient needs via EMR to provider or staff • Utilizes the electronic medical record/sources/tools as part of the assessment of utilization • Performs the duties within the scope of practice: Assessment, planning, implementation, coordination, monitoring and evaluation of assigned patients. Prioritizes patient assignments according to the intensity of the needs and required follow-up. Identifies patients in need of care management/chronic disease management services by utilizing generated reports to identify patients that require care management. Refers patients to care management services as indicated. • Evaluation of the plan of care of assigned patients: Assesses the effectiveness of the patient's plan of care in achieving the established goals. Revises and updates the patient's plan of care as needed to reflect any identified change in the patient's needs, such as but not limited to any identified issues/concerns. • Documents (accurate and timely) to include but not limited to: Initial and ongoing assessments. Care plan development and evaluation if indicated. Maintenance of any established database. • Outcome analysis: Collects and analyses quality and outcome data to include generation of data reports. Represents the disease care management program in the areas of quality performance improvement to include but not limited to cost containment and prevention of over utilization of medical resources. • Demonstrates the ability to self-motivate, to work independently and autonomously, to priority set, to be adaptable to change and to make changes to improve work efficiencies and effectiveness. • Demonstrates the ability to make independent decisions within the scope of practice and the established policies and procedures. • Demonstrates the ability and confidence to seek out additional information, input, and assistance as needed in care managing the assigned patient population. • Demonstrates the ability to manage assigned case load. FINANCE • Seeks and engages in processes that improve clinical outcomes and cost savings. • Expedites the scheduling of tests and procedures as required to move patients through the system in a fiscally responsible way. • Works to promote cost containment through utilization management • Collaborate effectively with physicians and managed care representatives to ensure care is delivered in the appropriate setting. • Works to enhance the delivery of quality cost effective care • Recognizes areas of over utilization of services and intervenes as indicated • Maintains an expert working knowledge of payor/reimbursement systems as part of the utilization process. GROWTH • Seeks and engages in opportunities for personal and professional growth and development. Obtains required amount of CEU'S. • Maintains Maine State RN Licensure. • Attends monthly departmental meetings. • Attends all mandatory department and EMMC in-service training programs. • Reads and initials 100% of meeting minutes if not in attendance. • Maintains competency in order to perform care management duties for ages served in his/her case load. • Assumes responsibility for own self-development.
Other Information:
BLS Required.
Competencies and Skills

• 3+ years of relative work experience required.
• 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
• BLS is Required
• 3+ Years of Experience is Required

Education

• Associate's Degree Required or Bachelor's Degree Preferred

Working Conditions

• Work with computers, typing, reading or writing.
• Lifting, moving and loading 30 to 50 pounds.
• Prolonged periods of sitting.
• Alternate shift schedules (day, evening, nights, weekends).

Northern Light Eastern Maine Medical Center is a 411- bed, regional tertiary care hospital and an American College of Surgeons-verified Level II Trauma Center. Located in Bangor, Maine, it serves as the principal referral center for a patient population of 500,000 residents across the northern two-thirds of the state. The medical center provides comprehensive inpatient and outpatient services, including advanced surgical care, neurosciences, cardiovascular medicine, oncology, and critical care.
Eastern Maine Medical Center is the base for LifeFlight of Maine, a critical care air medical transport program that conducts nearly 900 missions annually, ensuring timely access to specialized care for rural and remote communities. As a member of Northern Light Health, the medical center is part of an integrated statewide health system comprising nine hospitals, numerous primary and specialty care practices, long-term care facilities, home health and hospice agencies, and emergency ground and air transport services. This integrated model supports coordinated, patient-centered care across the continuum.
Eastern Maine Medical Center plays a central role in advancing clinical quality, operational efficiency, and health equity throughout the region. It is actively engaged in clinical education and serves as a training site for medical students, residents, and fellows through affiliations with academic and professional institutions.
Bangor, Maine offers a stable and supportive environment for healthcare professionals. The region is home to high-performing public and private schools, including the University of Maine's flagship campus in Orono. Bangor International Airport provides convenient commercial air service with direct and connecting flights to major US hubs. The area also offers access to a wide range of cultural, educational, and recreational opportunities, with outdoor activities available year-round in Maine's forests, lakes, mountains, and coastal regions.
Northern Light Eastern Maine Medical Center is a strategic hub for clinical excellence, innovation, and community health in northern New England.
Questions? Contact Talent Acquisition:
phone: 207-973-7100
email: talentacquisition@northernlight.org
EMMC, Bangor, Maine, Level 2 Trauma Center, hospital, Cancer Care, Lifeflight