- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible for ensuring the receipt ... reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well… more
- Cognizant (Augusta, ME)
- …Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... as well as timely filing deadlines and processes. + Review clinical denials including but not limited to referral,...Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan +… more
- Evolent (Augusta, ME)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Oracle (Augusta, ME)
- …(ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal ... a prominent academic medical center in the Midwest. This remote role will act as the primary subject matter...offer ongoing consultation to support user proficiency and system utilization . Monitor project outcomes, track key metrics, and report… more