Travel Nurse RN - Long-Term Care - $53 to $55 per hour in Camden, ME

Registered Nurse (RN) | Long-Term Care
Location: Camden, ME
Agency: Conflux Systems Inc
Pay: $53 to $55 per hour
Shift Information: Days - 3 days x 12 hours
Contract Duration: 13 Weeks
Start Date: ASAP

About the Position

Job Summary

An RN Utilization Management (RN UM) is a licensed  Registered Nurse responsible for reviewing and evaluating the medical necessity, appropriateness, and efficiency of healthcare services. This role ensures patients receive the right level of care while optimizing resource use and maintaining compliance with healthcare regulations and payer guidelines.

Key Responsibilities

• Review patient records to assess medical necessity and appropriateness of care
• Perform utilization reviews (prospective, concurrent, and retrospective)
• Collaborate with physicians, case managers, and healthcare teams to develop cost-effective care plans
• Ensure compliance with insurance guidelines, regulatory standards, and facility policies
• Coordinate with insurance providers for authorizations and continued stay approvals
• Identify opportunities to improve quality of care and reduce unnecessary costs
• Document findings and maintain accurate records in utilization management systems
• Assist with discharge planning and transitions of care
• Monitor length of stay and resource utilization
• Participate in audits and quality improvement initiatives

Requirements

Requirements & Qualifications

• Valid RN license (state-approved)
• Associate Degree in Nursing (ADN) required; BSN preferred
• Minimum 2–3 years of clinical nursing experience (acute care preferred)
• Experience in utilization management, case management, or insurance review preferred
• Knowledge of healthcare regulations, payer guidelines, and reimbursement processes
• Familiarity with tools such as  InterQual Criteria or  MCG Guidelines
• Strong analytical, critical-thinking, and decision-making skills
• Excellent communication and documentation abilities

#0119