- 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
- Humana (Augusta, ME)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support the ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- Elevance Health (South Portland, ME)
- …medical decisions to members and providers. **Job Summary:** + Perform physician-level case review , following initial nurse review , of Medical Oncology ... regimens and supportive care. + 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
- 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
- Elevance Health (South Portland, ME)
- ** Nurse Reviewer I** **Location:** Within 50 miles of a pulse point **Shift** : Monday - Friday, from 9:30 am - 6 pm The ** Nurse Reviewer I** is responsible for ... on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. Partners with… 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 (Bangor, ME)
- …Per Week: 40.00 Work Schedule: 8:00 AM to 5:00 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
- Fresenius Medical Center (Biddeford, ME)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… 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
- 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
- First Atlantic Health Care (Saco, ME)
- …judgment, and critical thinking skill CERTIFICATES and LICENSES + Currently a registered nurse /licensed in Maine. + Certification upon hire or obtain it during ... policies, and procedures of the Nursing Services department. + Review and analyze facility activities and data to aid...and cash and risk management and to improve service utilization . + Prepare activity reports to inform management of… more
- First Atlantic Health Care (Freeport, ME)
- …become certified within the first year of employment. + Currently a registered nurse /licensed in Maine. + Certification upon hire or obtain it during orientation. ... policies, and procedures of the Nursing Services department. + Review and analyze facility activities and data to aid...and cash and risk management and to improve service utilization . + Prepare activity reports to inform management of… more