- Martin's Point Health Care (Portland, ME)
- …certified as a "Great Place to Work" since 2015. Position Summary Job Description The Utilization Review Nurse works as is responsible for ensuring the ... reviews for retrospective authorization requests as well as claims disputes.The Utilization Review Nurse will use appropriate governmental policies as well… more
- Lincoln Financial (Augusta, ME)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
- Zurich NA (Augusta, ME)
- AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is seeking an AVP, Utilization Review & Pharmacy. This is a fully remote position, offering ... flexibility of a home-based office. As the AVP of Utilization Review & Pharmacy, you will lead...of experience in the Nursing areaAND + Registered Professional Nurse license in residential area and in operational national/local… more
- Northern Light Health (Bangor, ME)
- …health care delivery to achieve optimal quality and financial outcomes. * Provides ongoing utilization review of primary care patients. Review for over ... Practice Case Management Department * Manages assigned case load, assessing utilization of resources and services; identifying all patient that require additional… more
- Evolent (Augusta, ME)
- …adjudication of processed appeals. **What You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management Review as an LPN or LVN ... the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact as part of… more
- Northern Light Health (Pittsfield, ME)
- …Type: Full Time Work Schedule: 8:00 AM to 4:30 PM Summary: The Registered Nurse II is a fully competent practitioner of nursing. The incumbent is responsible for ... according to the Rules and Regulations defined in the State of Maine Nurse Practice Act Northern Light Health Standards of Care/Practice, policies and procedures.… more
- Northern Light Health (South Portland, ME)
- …palliative care experience. Our Portland region has a great position for a registered nurse wanting to make a positive difference in someone's life! You would be ... Hospice for at least 90 days (first time rehire only) Summary: The Registered Nurse II is a fully competent practitioner of nursing. The incumbent is responsible for… more
- Northern Light Health (Pittsfield, ME)
- …(minus tax) sign on bonus that is paid out incrementally. Summary:The Registered Nurse II is a fully competent practitioner of nursing. The incumbent is responsible ... according to the Rules and Regulations defined in the State of Maine Nurse Practice Act, Northern Light Health Standards of Care/Practice, policies and procedures.… more
- Northern Light Health (Ellsworth, ME)
- …Per Week: 40.00 Work Schedule: 8:00 AM to 5:00 PM Summary: The Registered Nurse II is a fully competent practitioner of nursing. The incumbent is responsible for ... according to the Rules and Regulations defined in the State of Maine Nurse Practice Act, Northern Light Health Standards of Care/Practice, policies and procedures.… more
- Northern Light Health (Pittsfield, ME)
- …(minus tax) sign on bonus that is paid out incrementally. Summary: The Registered Nurse II is a fully competent practitioner of nursing. The incumbent is responsible ... Rules and Regulations defined in the State of Maine Nurse Practice Act Northern Light Health Standards of Care/Practice,...+ Resource Management + + Identifies opportunities to improve utilization of resources. + Professional Development + + Takes… more
- Northern Light Health (Blue Hill, ME)
- …PRN Hours Per Week: No Hours Assigned Work Schedule: Variable Summary: Registered Nurse II is a fully competent practitioner of nursing. The incumbent is responsible ... according to the Rules and Regulations defined in the State of Maine Nurse Practice Act, Northern Light Health Standards of Care/Practice, policies, and procedures.… more
- CVS Health (Augusta, ME)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- CVS Health (Augusta, ME)
- …with transferring patients to lower levels of care. - 1+ years' experience in Utilization Review . - CCM and/or other URAC recognized accreditation preferred - 1+ ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Sharecare (Augusta, ME)
- …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is ... To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and objectives of the… more
- Evolent (Augusta, ME)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Highmark Health (Augusta, ME)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… 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...nursing with up to six (6) months of Registered Nurse experience. + Current RN license within the state… more
- First Atlantic Health Care (Saco, ME)
- …programs, goals, objectives, policies, and procedures of the Nursing Services department. + Review and analyze facility activities and data to aid planning and cash ... and risk management and to improve service utilization . + Prepare activity reports to inform management of...and critical thinking skills Requirements: + Currently a registered nurse /licensed in Maine. + CPR Certification upon hire… more
- First Atlantic Health Care (Saco, ME)
- …judgment, and critical thinking skill CERTIFICATES and LICENSES + Currently a registered nurse /licensed in Maine. + Certification upon hire or obtain it during ... policies, and procedures of the Nursing Services department. + Review and analyze facility activities and data to aid...and cash and risk management and to improve service utilization . + Prepare activity reports to inform management of… more
- Evolent (Augusta, ME)
- …years of direct clinical patient care + **Minimum one year of experience with Utilization Review (UM) in a managed care environment** + **Cardiology and Oncology ... + Performs other duties as assigned. **Qualifications: Required and Preferred:** + Licensed registered nurse or LVN/LPN (current and unrestricted) + Minimum of three… more