- 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 a team responsible for ... reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well… more
- Elevance Health (South Portland, ME)
- …as part of consideration for employment. **Medical Oncology Medical Director - Utilization Review ** + Job Family: MED > Licensed Physician/Doctor/Dentist + ... 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
- Humana (Augusta, ME)
- …help us put health first** Full-Time Remote, Telephonic RN opportunity. The Utilization Management Behavioral Health Nurse utilizes behavioral health knowledge ... three (3) years of clinical and Utilization Management experience. The Utilization Management Behavioral Health Nurse completes medical record reviews from… more
- Humana (Augusta, ME)
- …+ Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Experience compiling NCQA File Review Universes and timeliness ... Qualifications** + Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health. + Detailed working knowledge in… 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 (Pittsfield, ME)
- …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 (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 (Waterville, ME)
- …Per Week: 40.00 Work Schedule: 8:00 AM to 8:30 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
- Covenant Health (Lewiston, ME)
- …are attended /documented. Annual goals are achieved. Attends pertinent case management/ utilization review programs to maintain current knowledge of UR ... and communication. Supports the role of the clinical primary nurse and utilizes their clinical expertise and input in...medical necessity (whether based on initial or continuing stay review ) to determine whether a level of care change… 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 Care - Case Management Department (s): 81810 CARE… more
- Marriott (Augusta, ME)
- …workers' compensation losses. The NCM is responsible for conducting first level Utilization Review and coordinates subsequent levels if necessary, as required ... **Additional Information** Nurse CARE Manager (CARE - Coordinated Action and...that may include multiple states. + Conducts first level utilization review per jurisdictional requirements. + Coordinates… more
- Humana (Augusta, ME)
- …may include, but not be limited to, Pre-Certification, Care Management, Utilization Management, and/or Compliance. + Plans, coordinates, and implements training ... update training for UM nurses. + Develops programs to improve UM nurse competencies (critical thinking skills, interpreting criteria, communication with providers to… more
- Lincoln Financial Group (Augusta, ME)
- …setting including 1 year in claims, disability management (STD/LTD), worker's compensation, utilization review , and or behavioral health case management . ... You will collaborate with Independent Consulting Physicians, Claims Specialists, and Nurse Disability Consultants to assist with reviewing and assessing mental… more