Top 18 Utilization review nurse Jobs in Orono, Me

NEUROSURGERY NURSE NAVIGATOR & SURGICAL CLINICAL REVIEWER
St. Joseph's Healthcare —Bangor, ME
- $69,537.63 - $95,764.16 a year
- Full-time
- Nursing
- Surgery
- RN License
Case Manager Registered Nurse - Per Diem Bangor, ME
UnitedHealth Group —Bangor, ME
- $29 - $52 an hour
- Weekends as needed
- Acute care
- Nursing
- RN License
Case Manager RN - Per Diem
Optum —Bangor, ME
- $29 - $52 an hour
- Full-time
- Remote
- Nursing
- RN License
- Hospital
10h
Case Manager RN
Optum —Bangor, ME
- $60,200 - $107,400 a year
- Full-time
- Nursing
- RN License
- Hospital
11d
Case Manager Registered Nurse
Optum —Bangor, ME
- $60,200 - $107,400 a year
- Full-time
- Acute care
- Nursing
- RN License
Case Manager Registered Nurse - Per Diem Bangor, ME
Optum —Bangor, ME
- $29 - $52 an hour
- Part-time
- Acute care
- Nursing
- RN License
RN Unit Manager
Vbeyond Corporation —Orono, ME
- $55 - $60 an hour
- Contract
- Skilled nursing facility
- RN License
- BLS Certification
Quick Apply
16h
Licensed Practical Nurse
TalentBurst, Inc. —Orono, ME
- $954 - $972 a week
- Contract
- CPR Certification
- Nursing
- Computer literacy
- Health insurance
- Dental insurance
Quick Apply
11d
Residency Nurse - Primary Care - EMMC
Northern Light Health —Bangor, ME
- Weekends as needed
- Nursing
- RN License
- Computer literacy
- Continuing education credits
Nurse Practitioner
Clay Consulting —Bangor, ME
- $65 - $72 an hour
- Extended hours
- Nursing
- Blood sampling
- Microsoft Excel
Quick Apply
Utilization Management Reviewer
Amerihealth Caritas —United States
- Full-time
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Paid holidays
- Health insurance
Claims Nurse (Utilization Management / Claims Review) Must have CALIFORNIA license
Dragonfly Global —United States
- $100,000 - $105,000 a year
- Full-time
- Remote
- LVN
- RN License
- Mid-level
- Travel reimbursement
- Health savings account
Quick Apply

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Case Manager Registered Nurse - Per Diem Bangor, ME
UnitedHealth Group —Bangor, ME
Current, unrestricted Registered Nurse license in the state of Maine. Continuum of Care planning will emphasize education and collaboration with physicians,…
$29 - $52 an hour
Case Manager RN - Per Diem
Optum —Bangor, ME
Current, unrestricted compact RN license in the state of residence. Continuum of Care planning will emphasize education and collaboration with physicians,…
$29 - $52 an hour
10h

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Case Manager / PRN ( RN / RT / SW / LPN )
Select Specialty Hospital - Columbus Vic Village(Grant) —Columbus, OH
Current licensure in a clinical discipline either as a Nurse (RN /LPN/ LVN)or a Respiratory Therapist OR current license / certified Social Work license per…
Quick Apply
Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…

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NEUROSURGERY NURSE NAVIGATOR & SURGICAL CLINICAL REVIEWER

St. Joseph's Healthcare -
Bangor, ME

Apply Now

Job Details

Full-time
$69,537.63 - $95,764.16 a year

Qualifications

RN License
Bachelor's degree

Full Job Description

Job Summary:

Position Summary:

The Neurosurgery Nurse Navigator & Surgical Clinical Reviewer (SCR) serves in a dual role supporting both the neurosurgical patient population and surgical quality improvement initiatives. This position works in close collaboration with Neurosurgery providers, Perioperative Services, and Quality leadership, and functions as an advocate, educator, coordinator, and guide for neurosurgical patients and their families throughout the surgical continuum. The role also supports surgical quality improvement through participation in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP).

The Neurosurgery Nurse Navigator is responsible for facilitating the patient experience by guiding patients across the continuum of care. The Navigator serves as the primary point of contact for patients and families and acts as an intermediary between the patient, care providers, and hospital resources. Responsibilities include patient education, care coordination, discharge planning, transition management, and post-treatment follow up.

In the Surgical Clinical Reviewer (SCR) role, the employee is responsible for the collection, abstraction, review, and submission of reliable surgical clinical data for ACS NSQIP participation and quality improvement activities. The SCR collaborates closely with surgeons, nursing staff, quality leadership, and interdisciplinary teams to support data integrity, identify opportunities for improvement, and support organizational quality initiatives.

This position consists of approximately 50 % Neurosurgery Nurse Navigator responsibilities and 50% Surgical Clinical Reviewer (SCR) responsibilities. Allocation of responsibilities may shift based on organizational priorities, patient volumes, ACS NSQIP program requirements, and service line needs.

Position Responsibilities:

The Neurosurgery Nurse Navigator & SCR will coordinate all aspects of care and quality review in a collaborative manner with members of the healthcare team to facilitate high quality, comprehensive patient care and surgical quality improvement. . This role supports the organizational goals related to patient outcomes, surgical quality, patient experience, care coordination, and reduction of avoidable complications and readmissions.

Responsibilities include:

1. Manage the transition of neurosurgical patients across the continuum of care and within specific clinical settings.

Related responsibilities may include:

Initial and ongoing care coordination across all providers as patients transition through the surgical continuum.

Ensure appropriate pre-operative preparation for every patient.

Assist providers in coordinating patient care with other healthcare professionals and community resources when necessary.

Follow up with patients and providers regarding patient response to treatment and recovery progress.

Provide accurate, ongoing documentation of navigation and care coordination activities within the EHR.

Provide pre-operative and post-operative education and educational resources to patients and families.

Support patients and families in coping with the psychological and emotional aspects of neurosurgical diagnoses and procedures.

Identify barriers to care including transportation, social determinants of health, caregiver support, and discharge planning needs.

Coordinate post-discharge follow up and support patients through recovery to help reduce avoidable complications and readmissions.

2. Serve as the primary point of contact between the patient, family members, providers, and care team.

Coordinate communication between inpatient units, provider offices, rehabilitation services, care management, ancillary departments, and external healthcare organizations.

Maintain professional communication with provider offices, nursing units, ancillary departments, and coworkers.

3. Serve as a source of feedback and support for active review of program protocols, care pathways, and service offerings.

Participate in program development and quality improvement initiatives related to neurosurgical care.

Assist in identifying opportunities to improve patient experience, care coordination, and outcomes.

4. Assist in the collection, review, and analysis of clinical data, metrics, and quality information.

Support program scorecards, quality dashboards, and performance improvement initiatives.

Participate and/or facilitate, quality meetings and interdisciplinary discussions as requested.

5. Perform Surgical Clinical Reviewer (SCR) responsibilities in support of ACS NSQIP participation.

Identify surgical patients for inclusion in ACS NSQIP utilizing established inclusion/exclusion criteria.

Collect pre-operative, operative, and post-operative clinical data utilizing hospital medical record systems.

Ensure accurate and timely abstraction and entry of data into ACS NSQIP databases.

Collaborate with surgeons, nursing leadership, quality staff, and ancillary departments to support surgical quality improvement efforts.

Assist in preparation and presentation of surgical quality data and outcomes information.

Qualifications:

Education:

Four-year college (Bachelor’s Degree) required

Graduate (Master’s Degree) preferred

Years of Experience:

3 – 5 years

Licensure(s):

State of Maine License for Registered Nurses (Or Compact State)

Certification(s):

BLS within 30 days of employment

Ability to complete ACS NSQIP SCR training and certification requirements within 60-90 days of hire

Covenant Health Mission Statement

We are a Catholic health ministry, providing healing and care for the whole person, in service to all in our communities.

Our Core Values:

Compassion

We show respect, caring and sensitivity towards all, honoring the dignity of each person, especially the poor, vulnerable and suffering.

Integrity

We promote justice and ethical behavior, and responsibly steward our human, financial and environmental resources.

Collaboration

We work in partnership, dialogue and shared purpose to create healthy communities.

Excellence

We deliver all services with the highest level of quality, while seeking creative innovation.

Applicants, employees and former employees are protected from employment discrimination based on race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age (40 or older), disability, and genetic information (including family medical history).

Comp Range:

$69,537.63 - $95,764.16

Rate of pay displayed reflects the beginning of the pay scale. At the time of an offer, determination of your offer will reflect your skills and experience as it relates to the position.

Our people make the difference. See firsthand what makes our employees and culture shine!

Apply Now

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utilization review nurse jobs in orono, me

NEUROSURGERY NURSE NAVIGATOR & SURGICAL CLINICAL REVIEWER

Case Manager Registered Nurse - Per Diem Bangor, ME

Case Manager RN - Per Diem

Case Manager RN

Case Manager Registered Nurse

Case Manager Registered Nurse - Per Diem Bangor, ME

RN Unit Manager

Licensed Practical Nurse

Residency Nurse - Primary Care - EMMC

Nurse Practitioner

Utilization Management Reviewer

Claims Nurse (Utilization Management / Claims Review) Must have CALIFORNIA license

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