- Evolent (Augusta, ME)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as... medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all… more
- Northern Light Health (Ellsworth, ME)
- …services. Northern Light Maine Coast Hospital is dedicated to providing exceptional medical care with the personal touch and convenience only a community hospital ... is part of a non-profit organization. Summary: The Registered Nurse I is a Registered Nurse who...and skills in location, operation, and care of equipment. Clinical Assessments + Performs and documents systematic assessments according… more
- Northern Light Health (Ellsworth, ME)
- …per Week Work Schedule: 8:00 AM to 5:00 PM Summary: The Licensed Practical Nurse is responsible for providing basic nursing attention to patients and attending to ... 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
- Veterans Affairs, Veterans Health Administration (Togus, ME)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Responsibilities These Registered Nurse - Residential Rehabilitation Treatment Program positions are located...environment of care rounds, and respond to psychiatric and medical care needs and emergencies as directed. Report safety… more
- CenterWell (Augusta, ME)
- …complaints. + Makes clinical level of care determination based on discussion, medical records, and any other pertinent clinical data. Matches these needs to ... to work every other holiday.** The **Care Manager, Telephonic Nurse ** helps to ensure optimal continuity of care for...Health, Hospice, and Palliative Care Services. + Assist with clinical eligibility review for alternate services +… more
- Datavant (Augusta, ME)
- …years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS or ... realize our bold vision for healthcare. **What We're Looking For:** As a Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role… more
- Highmark Health (Augusta, ME)
- …:** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** This job performs clinical review and data abstraction of patient records to support ... Preferred + Associate's or Bachelor's Degree in Nursing + 1 year performing medical record review and data abstraction for cardiovascular registries + Proficient… more
- CenterWell (Augusta, ME)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience,...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Oracle (Augusta, ME)
- …+ Excellent communication, stakeholder engagement, and leadership skills. **Preferred Qualifications:** + Clinical experience as a nurse or physician with a deep ... **Job Description** The Clinical Note AI Agent Product Management Leader will...Gather and analyze information to define product specifications and review design specifications. Envision and communicate product strategy and… more
- Zurich NA (Augusta, ME)
- Sr Supplier Medical Process Specialist 128416 Zurich North America is seeking am experienced Sr. Supplier Medical Process Specialist to join our team in one of ... commitment to work/life balance, and outstanding culture. As a Sr. Supplier Medical Process Specialist, you will manage supplier performance and work product in… more
- Fresenius Medical Center (Gardiner, ME)
- …dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with organization policies, procedures, and training and in compliance ... and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine...activities. + Enters all treatment data into the designated clinical application in an accurate and timely manner. +… more
- Fresenius Medical Center (Bath, ME)
- …counseling services to patients as permitted within the scope of their clinical training and state license. + Provides educational and goal directed counseling ... and the patient's family/support persons. + In collaboration with the physician and nurse , participates in the discussion of patient DNR status in the facility to… more
- Oracle (Augusta, ME)
- …(ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal ... of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will… more
- Sedgwick (Augusta, ME)
- …**PRIMARY PURPOSE** **:** To manage complex high-exposure general liability claims; to review medical treatment records associated with general liability, bodily ... related clinical nursing experience to include two (2) years nurse consultant experience or equivalent combination of education and experience required.… more
- CenterWell (Augusta, ME)
- …are excited to offer the role of Virtual Physician Collaborator for CenterWell Medical Group, a new virtual care delivery group within CenterWell Senior Primary ... in care, ensuring timeless access to important medications and solving urgent clinical needs. This Virtual Physician Collaborator shares in our vision to innovate… more
- Highmark Health (Augusta, ME)
- …and retrospective claims review basis. Review process includes a review of medical documentation, itemized bills, and claims data to assure appropriate ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or… more
- Intermountain Health (Augusta, ME)
- …Assessment** : Identifies patients for proactive interventions using specific screening criteria, medical record review , payor models, medical risk scores, ... comprehensive ambulatory care management services to identified patients. Leveraging clinical expertise, this role involves conducting care management screenings,… more
- Merck (Augusta, ME)
- …(Oncology group purchasing organizations, wholesalers, and specialty pharmacies). + Review and evaluate patterns for products purchased and prescribed (outpatient ... the in-scope customer team: Customer Team Leader, Key Account Manager, Nurse Educator, Field Reimbursement Associate, Medicare Account Executive, and more.… more
- Veterans Affairs, Veterans Health Administration (Togus, ME)
- …VHA Education Loan Repayment Services program office after EDRP application review . Former EDRP participants are ineligible to apply. Responsibilities In conjunction ... with the surgical or medical attending physician and other consultants, the Pulmonologist/Intensivist (hereafter PI) directs the care of all patients in the… more
- Northern Light Health (Belfast, ME)
- …improve mental health, and in conjunction with the primary care provider, improve medical health to adults with serious and persistent mental illness and children ... providers in support of client's treatment plan, including, but not limited to BHH Nurse Care Managers and Peer Support staff, in a regular and professional manner +… more