Utilization Review Jobs in Lewiston, ME (NOW HIRING)

Central Maine Healthcare (CMH), a member of Prime Healthcare Foundation, is an integrated healthcare delivery system serving approximately 400,000 residents across central, western, and midcoast Maine through a network of more than 40 primary and specialty care locations. The system includes Central Maine Medical Center  (CMMC) in Lewiston, a 250-bed, not-for-profit regional referral hospital that is home to the region's only Cancer Care Center, an orthopedic ambulatory surgery center, and the Central Maine Heart and Vascular Institute. CMMC also serves as the central Maine base for LifeFlight of Maine, the state's only medical helicopter service.

CMH also includes Bridgton Hospital and Rumford Hospital, two 25-bed critical access hospitals that provide essential care to Maine's rural communities.

As part of its commitment to healthcare education and workforce development, CMH is home to the Maine College of Health Professions, Maine's first nursing and medical imaging school. The private, not-for-profit institution is accredited by the New England Commission of Higher Education and plays an important role in training the next generation of healthcare professionals.

To learn more, visit www.cmhc.org.

Coordinates and completes the clinical reviews for all patient medical records while working closely with CMO (Chief Medical Officer). Actively participates in the Case management and UR meetings. Serves as on-going educator to all departments.  Responsible for reviewing patient charts in order to assess whether the clinical criteria for admission and continuation of treatment is being met; gathering data and responding to request for records from payers/fiscal intermediary etc.; gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and use sound judgment.  Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment.  Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families. Performs other duties as assigned.

EDUCATION, EXPERIENCE, TRAINING

Required qualifications:

1.    Master of Public Health (MPH) or post-graduation in a related health care field is required.

2.    Medical Graduate, Dental Graduate required.

3.    Knowledge of Clinical Pathophysiology and Pharmacology required.

Preferred qualifications:

1.    ECFMG Certification And/or Bachelor’s or higher from a US-based accredited institution in a Health and Human Services field is highly preferred.

2.    Utilization Review/Case Management experience is highly preferred. 

3.    1+ year of clinical experience in acute care setting preferred.

4.    Excellent written and verbal communication skills. Excellent critical thinking skills.

5.    Excellent interpersonal skills to build effective partnering relationships with physicians, nurse staff, coding staff and hospital management staff.

6.    Ability to work independently in a time-oriented environment.

7.    Computer data entry with 10-key preferred, with accurate typing speed of 35 wpm preferred.

Central Maine Medical Center offers competitive compensation and a reasonable compensation estimate for this role is $28.00 to $43.41. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

The company is dedicated to empowering its staff with a comprehensive, competitive benefits package, allowing them the freedom to customize their benefits to fit their unique needs. Our abundant resources, programs, and voluntary options serve as a foundation for individual growth and well-being. Learn more here: https://www.primehealthcare.com/benefitsthatmattermost/

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf