- 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...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse ( RN ) in a… more
- CVS Health (Augusta, ME)
- …+ Active and good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC ... experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal… 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the… more
- Cognizant (Augusta, ME)
- …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- CenterWell (Augusta, ME)
- …clinical experience. + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Intelligence + ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...Experience with Home Health preferred + Previous experience in utilization management within Insurance industry a plus… 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 ... + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital… 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 ... strong willingness to relieve the suffering of others. Credentials + Required Registered Nurse Education + Required Associate's Degree Associate's or Bachelor's… more
- CVS Health (Augusta, ME)
- …is subject to change based on business needs. **Preferred Qualifications** 6+ months Case Management or Utilization Management experience Case Management ... however, it is subject to change based on business needs.** The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating… more
- Northern Light Health (Brewer, ME)
- …the next 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 ... Ability to travel in assigned service area. Summary: The Registered Nurse II is a fully competent...the interdisciplinary team to maximize patient care. + Resource Management - Identifies opportunities to improve utilization … more
- Northern Light Health (Blue Hill, ME)
- …Work Type: PRN Hours Per Week: No Hours Assigned Work Schedule: Variable Summary: Registered Nurse II is a fully competent practitioner of nursing. The incumbent ... Practice Act, Northern Light Health Standards of Care/Practice, policies, and procedures. The Registered Nurse II is responsible for the delivery of patient care… more
- Northern Light Health (Pittsfield, ME)
- …Type: PRN Hours Per Week: 8.00 Work Schedule: 7:00 AM to 4:00 PM Summary: The Registered Nurse II is a fully competent practitioner of nursing. The incumbent is ... Light Health Standards of Care/Practice, policies and procedures. The Registered Nurse II is responsible for the...the interdisciplinary team to maximize patient care. * Resource Management o Identifies opportunities to improve utilization … more
- Northern Light Health (Pittsfield, ME)
- …Valley Hospital Work Type: Part Time Eligible Hours Per Week: 20.00 Summary: The Registered Nurse II is a fully competent practitioner of nursing. The incumbent ... Practice Act Northern Light Health Standards of Care/Practice, policies and procedures. The Registered Nurse II is responsible for the delivery of patient care… more
- Humana (Augusta, ME)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- Healthfirst (ME)
- The Case Manager, Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review, discharge planning, ... case management as assigned. The Case Manager, Utilization Management is also responsible for efficient...necessary + Additional duties as assigned Minimum Qualifications: + RN , LPN, LMSW, LMHC, LMFT, LCSW, PT, OT, and/or… more
- Highmark Health (Augusta, ME)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… 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 ... performing the job functions. **Required Qualifications** - 5+ years' experience as a Registered Nurse with hospital experience; preferably in the specialty. - A… more
- Highmark Health (Augusta, ME)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more
- CVS Health (Augusta, ME)
- …+ 5-7 years of regulatory and/or clinical audit experience. + Experience in medical management , including Utilization Management (UM) and Case Management ... accreditation processes, and NCQA standards. + Licensed clinical professional ( RN preferred). + Excellent analytical, organizational, and communication skills. +… more
- Evolent (Augusta, ME)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... in a regulatory role (preferred). **LICENSE/CERTIFICATION:** Current, unrestricted state PA or RN /NP license in medicine or required specialty. Of a PA, obtaining a… more
- CenterWell (Portland, ME)
- …auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience. + Home health experience ... sit on-site at our Portland, ME branch location.** The ** RN Clinical Manager** coordinates and oversees all direct care...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more