- Humana (Augusta, ME)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Augusta, ME)
- **Become a part of our caring community and help us put health first** 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
- Martin's Point Health Care (Portland, ME)
- …of clinical nursing experience as an RN, preferably in a hospital setting + Utilization management experience in a health plan UM department Required License(s) ... "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible...to lower/higher levels of care, makes referrals for care management programs, and performs medical necessity reviews for retrospective… more
- CVS Health (Augusta, ME)
- …clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… more
- CVS Health (Augusta, ME)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… 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)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- CVS Health (Augusta, ME)
- …we do it all with heart, each and every day. Drives effective utilization management practices by ensuring appropriate and cost-effective allocation of ... efficient use of healthcare resources. Applies clinical expertise and knowledge of utilization management principles to influence stakeholders and networks of… 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 ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Northern Light Health (Pittsfield, ME)
- …+ Collaborates with the interdisciplinary team to maximize patient care. Resource Management + Identifies opportunities to improve utilization of resources. ... Work Type: Part Time Eligible Hours Per Week: 20.00 Summary: The Registered Nurse II is a fully competent practitioner of nursing. The incumbent is responsible… more
- Northern Light Health (Brewer, ME)
- …Collaborates with the interdisciplinary team to maximize patient care. + Resource Management - Identifies opportunities to improve utilization of resources. + ... Bangor region has a great position for a registered nurse wanting to make a positive difference in someone's...+ Leadership and Professional Conduct - Utilizes appropriate time management and meets the expectations for punctuality and attendance.… 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 (Brewer, ME)
- …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 ... 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
- Wellpath (Windham, ME)
- …of care support. **How you make a difference** The Psychiatric Nurse Practitioner(Psych NP)follows established policies and procedures and state guidelines, ensuring ... through proper documentation. Theyprovidepsychiatric consultation, diagnostic, treatment, and medication management services to patients, including crisis intervention services. Overall,… 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 ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… 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, ... review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts… more
- Sharecare (Augusta, ME)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Northern Light Health (Portland, ME)
- …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 ... + Completes annual staff training and ensures staff completion. Operations Management + Exercises leadership style that fosters collaboration, cooperation, and team… more
- First Atlantic Health Care (Saco, ME)
- …and analyze facility activities and data to aid planning and cash and risk management and to improve service utilization . + Prepare activity reports to inform ... equipment, and services. + Develop and maintain computerized record management systems to store and process data such as...and critical thinking skills Requirements: + Currently a registered nurse /licensed in Maine. + CPR Certification upon hire… more
- Genesis Healthcare (Orono, ME)
- … Management and AlignMed Partners to oversee the implementation, utilization , and outcomes measurement of AlignMed Partners Clinical Programs. The Medical ... among residents of skilled nursing and senior living facilities. Our physicians, nurse practitioners (NPs) and physician assistants (PAs) are supported by a clinical… more