- Covenant Health (Lewiston, ME)
- …experience in utilization review , discharge planning, social work case management, or Utilization Manager experience preferred. + Certification ... skills and experience as it relates to the position. Summary The UR Case Manager conducts medical necessity reviews per the Utilization Management (UM) plan… more
- Central Maine Medical Center (Lewiston, ME)
- …of previous experience in Utilization Management and/or Care Management.*BSN preferred.Certified Case manager required within 2 years of hire. If you are ... and for each other every day. Position Summary: The Utilization Management Nurse is responsible for a comprehensive clinical... Management Nurse is responsible for a comprehensive clinical review to assess for medical necessity of outpatient and… more
- Central Maine Medical Center (Lewiston, ME)
- …plans, implements, and evaluates the needs of patients for discharge planning and utilization review . This includes those who may have Medicare, Medicaid, HMO, ... who have an ongoing caring relationship with the patient. Utilization review procedures include those stated for...Documentation meets current standards and policies. + Cooperates with Case Manager 's activities with the insurance company,… more
- Cardinal Health (Augusta, ME)
- …get life-changing therapies to patients who need them-faster.** **_Responsibilities_** The Senior Case Manager supports patient access to therapy through patient ... develop and execute effective solutions. + Provide guidance and training to junior case managers on best practices in case management, patient interaction, and… more
- Highmark Health (Augusta, ME)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective ** utilization management** strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/ case … more
- Central Maine Medical Center (Rumford, ME)
- …plans, implements, and evaluates the needs of patients for discharge planning and utilization review . This includes those who may have Medicare, Medicaid, HMO, ... who have an ongoing caring relationship with the patient. Utilization review procedures include those stated for...Documentation meets current standards and policies. + Cooperates with Case Manager 's activities with the insurance company,… more
- Evolent (Augusta, ME)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical...and findings with matrixed Physician Business Manager . + Provides medical direction to… more
- Highmark Health (Augusta, ME)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. ... industry, corporate, state, and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create care plans… more
- Northern Light Health (Bangor, ME)
- …being referred for admission and Hospital Outpatient Services. He/she presents case information to Clinical, Psychiatric and Nursing staff; schedules evaluations and ... after-hours back up to multiple Acadia departments including Registration, Utilization Management, Facilities, Ambulatory Clinic Scheduling and the Narcotic… more
- Elevance Health (South Portland, ME)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... ensuring clinical integrity of broad and significant clinical programs. May perform clinical review . **How you will make an impact:** + May provide clinical guidance… more
- Evolent (Augusta, ME)
- …Oncology clinical Q&As for provider portal, prior authorizations, lists, regimens, scope diagnoses, case review and related activities. + Review of Carepro ... value- based care and initiatives within pathway, policy, and beyond utilization management solutions. + Introduce innovative initiatives supported with evidence and… more
- Elevance Health (South Portland, ME)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.… more
- SitusAMC (Augusta, ME)
- …and colleagues in terms of clients' inquiries, model implementation issues and utilization . + Provides internal support to peers including peer report reviews and ... etc. + Such other activities as may be assigned by your manager Qualifications/ Requirements: + Bachelor's Degree in finance, economics, statistics, or mathematics… more