- Martin's Point Health Care (Portland, ME)
- …Point has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of the Utilization ... requiring clinical review prior to payment. The Utilization Review Nurse will use...nursing experience as a RN, with a focus of Utilization Management in a managed care environment.… more
- Elevance Health (South Portland, ME)
- **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On Bonus** ... members and providers. **Job Summary:** + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- Elevance Health (South Portland, ME)
- …**How you will make an impact:** + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, policies and ... ** Nurse Audit Lead** **Supports the Carelon Payment Integrity...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through… more
- Northern Light Health (South Portland, ME)
- …Collaborates with the interdisciplinary team to maximize patient care. + Resource Management - Identifies opportunities to improve utilization of resources. + ... Schedule: 7:45 AM to 8:15 PM Summary: The Registered Nurse II is a fully competent practitioner of nursing....+ Leadership and Professional Conduct - Utilizes appropriate time management and meets the expectations for punctuality and attendance.… more
- Covenant Health (Lewiston, ME)
- …to practice nursing in the State of Maine. + Three years' experience in utilization review , discharge planning, and/or social work; knowledge of third part payer ... St. Mary's Health System Job Description Position Title: Nurse Care Manager Position Title Specification : Acute...Manager Position Title Specification : Acute Care - Case Management Department (s): 81810 CARE MANAGEMENT Purpose… more