- 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
- HCA Healthcare (Portsmouth, NH)
- …including increased productivity, market share, cost controls and maximum utilization of facilities. Recommends improvement of hospital facilities in assigned ... goal setting and business development and budgeting. 3. Assure quality management plan is established with goal achievement documented and quality improvement… more
- Genesis Healthcare (Hampton, NH)
- …is required. *Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and/or case management is highly desirable. *Must ... take great pride in meeting or exceeding CDC and CMS standards. The MDS Nurse -- RN manages the overall process and tracking of all Medicare/Medicaid case-mix… more