- 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… 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 ... Management Department * Manages assigned case load, assessing utilization of resources and services; identifying all patient that...of care services, to include but not limited to home health services, long-term care, skilled level of care,… more
- Sharecare (Augusta, ME)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...minimum. + This position will be based in a home office which must satisfy all HIPAA requirements. Sharecare… more
- Northern Light Health (Brewer, ME)
- …Collaborates with the interdisciplinary team to maximize patient care. + Resource Management - Identifies opportunities to improve utilization of resources. + ... Isle, South Portland, Home Care, Hospice Care, end of life, respite care, Home Health Aide, Skilled Nursing Position Registered Nurse IILocation Req ID 83243 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
- 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
- Wellpath (Windham, ME)
- …memberships and product discounts * Preferred banking partnership and discounted rates for home and auto loans *Eligibility for perks and benefits varies based on ... of care support. **How you make a difference** The Psychiatric Nurse Practitioner(Psych NP)follows established policies and procedures and state guidelines, ensuring… 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 ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management ...all employees have the following technical capability at their home : High speed internet over 10 Mbps and, specifically… more
- CenterWell (Bangor, ME)
- …+ Two years as a Registered Nurse with at least one-year of management experience in a home care, hospice or equivalent environment. + Home ... : Bangor, ME **This is not a remote or work-from- home position. This position requires you to sit on-site...clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates… 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