Utilization Review Nurse (Remote- Maine RN Only) Job at Gainwell Technologies, Orono, ME

V2FDQWp0TjZYaERHdk5nbUpJL3FKSnB1R1E9PQ==
  • Gainwell Technologies
  • Orono, ME

Job Description

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. Summary We are seeking a skilled Utilization Review Nurse to conduct prior authorization, prospective, concurrent, and retrospective reviews for medical necessity and appropriateness of services, following clinical criteria, coverage policies, and contract guidelines. This involves reviewing medical documentation, accurately documenting findings, and ensuring policy compliance. Your role in our mission Review admissions, procedures, services, and supplies for medical necessity and appropriateness, meeting quality and production goals. Use clinical criteria for decision-making, referring complex cases to Medical Directors when needed. Engage with providers to gather clinical information, apply guidelines, and make determinations. Document findings and rationale in medical management systems. Assist in training new nurses, provide feedback, and stay updated on clinical guidelines. Maintain RN license and meet continuing education requirements. What we're looking for Active Maine RN license. 3+ years of inpatient clinical experience. 1+ year in prior authorization reviews using InterQual. Strong written communication skills in a fast-paced setting. Proficient in Microsoft Office and other computer applications. What you should expect in this role Home-based position within Maine. High-speed internet and a distraction-free workspace required. Core hours: 8:00 AM - 6:00 PM ET, with potential for extended hours. Occasional travel (up to 10%) based on business needs.

#LI-AC1

#LI-REMOTE

This position is for pipeline purposes, and we welcome applications on an ongoing basis. The pay range for this position is $49,200 - $70,300 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings. Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies

Job Tags

Full time, Contract work, Flexible hours,

Similar Jobs

Diversified Transfer and Storage, Inc.

Class A Local Truck Driving Jobs Available - SLC Job Job at Diversified Transfer and Storage, Inc.

Class A Local Truck Driving Jobs Available - SLC JobDiversified Transfer & Storage is currently seeking a local driver for our Salt Lake City location. Are you ready to earn $50,000 to $70,000 per year? If youve got at least 100,000 miles logged, and a clean recent driving... 

Highgate

General Manager Job at Highgate

 ...Highgate is a premier real estate investment and hospitality management company widely recognized as an innovator in the industry. Highgate...  ...integrity of the newly renovated luxury Huntington Hotel. Tour the operating departments daily, making adjustments as needed... 

Vans Interstate

Class A Truck Drivers - Owner Operators needed in West Michigan Job Job at Vans Interstate

Class A Truck Drivers - Owner Operators needed in West Michigan JobMasselink Brothers / Van's Interstate Service has openings in our Intermodal container fleet to run MI, IN and IL. Paid % of gross.We have years of experience in ELD compliance.Requires a good driving... 

Olympic Marketing Group

Sales Trainee Job at Olympic Marketing Group

 ...Olympic Marketing Group is passionate about delivering exceptional paid training and providing outstanding service to our top-tier client...  .... ~ Goal-oriented and highly motivated. ~ Willingness to relocate or travel if required for training. ~ Ability to work... 

TRAC Therapy Research Autism Center

BCBA BCaBA Work From Home Job at TRAC Therapy Research Autism Center

75% REMOTE! Work From Home T.R.A.C. Therapy Research Autism Center is seeking a result-driven BCBA to join our T.R.A.C. team. BCBA Requirements: Must have obtained a BCBA certification and be in good standing with the BACB (if applicable) LARA License (if...