- CVS Health (Augusta, ME)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Humana (Augusta, ME)
- …help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Augusta, ME)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical … more
- CVS Health (Augusta, ME)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... listening, and use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed,… more
- CVS Health (Augusta, ME)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- Evolent (Augusta, ME)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- Northern Light Health (Bangor, ME)
- …in a fiscally responsible way. * Works to promote cost containment through utilization management . * Collaborate effectively with physicians and managed care ... Case Management Department * Manages assigned case load, assessing utilization of resources and services; identifying all patient that require additional … more
- Sharecare (Augusta, ME)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- Northern Light Health (Brewer, ME)
- …Collaborates with the interdisciplinary team to maximize patient care. + Resource Management - Identifies opportunities to improve utilization of resources. + ... three to six months. Our Bangor region has a great position for a registered nurse wanting to make a positive difference in someone's life! You would be responsible… more
- CVS Health (Augusta, ME)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Northern Light Health (Brewer, ME)
- …by the Medical Director of the Integrated Transfer Center, the Transfer Center Nurse is responsible for obtaining clinical presentation data and coordinating the ... Hours Per Week: 12.00 Work Schedule: No Hours Assigned Summary: Transfer Center Nurse is a fully competent practitioner of nursing. The incumbent is responsible for… more
- Northern Light Health (Greenville, ME)
- …+ Collaborates with the interdisciplinary team to maximize patient care. Resource Management + Identifies opportunities to improve utilization of resources. ... 6:30 PM to 7:00 AM Eligible for a Sign on Bonus Summary: The Registered Nurse II is a fully competent practitioner of nursing. The incumbent is responsible for the… more
- Northern Light Health (Pittsfield, ME)
- …+ Collaborates with the interdisciplinary team to maximize patient care. Resource Management + Identifies opportunities to improve utilization of resources. ... Schedule: No Hours Assigned Eligible for a Sign on Bonus Summary: The Registered Nurse II is a fully competent practitioner of nursing. The incumbent is responsible… more
- Highmark Health (Augusta, ME)
- …Degree in Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical , case/ utilization management and/or disease/condition management ... panel of members that range in health status/severity and clinical needs; and assesses health management needs...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- Wellpath (Windham, ME)
- …month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan. We offer ongoing training and ... for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support. **How you make… more
- Evolent (Augusta, ME)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- CenterWell (Bangor, ME)
- …driver's license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... you to sit on-site at our** Bangor, ME **branch location.** The **RN Clinical Manager** coordinates and oversees all direct care patient services provided by … more
- Sharecare (Augusta, ME)
- …3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case ... / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical,… more
- Genesis Healthcare (Orono, ME)
- …Regional Management and AlignMed Partners to oversee the implementation, utilization , and outcomes measurement of AlignMed Partners Clinical Programs. The ... in Orono, ME. This is a Dual Role Attending Physician/Medical Director. It is clinical in nature. Must be BC/BE Internal Medicine or Family Medicine with LTC… more
- Northern Light Health (Portland, ME)
- …equipment and service vendors and ensures strong performance in supply chain management . + Maintains collaborative relationships with other clinical and non- ... PM Summary: The Administrative Manager is responsible for operational, financial and strategic management of his or her practice and is required to exercise a high… more