- 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 ... and communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- Highmark Health (Augusta, ME)
- …Highmark Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... + Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse ( RN ) license + Delaware RN … more
- Humana (Augusta, ME)
- …guidelines/procedures. **Use your skills to make an impact** **Required Qualifications** + Active Licensed Registered Nurse ( RN ) in the state of Virginia or ... licensure + Previous Medicare/Medicaid experience a plus + Previous experience in utilization management , case management , discharge planning and/or home… more
- Humana (Augusta, ME)
- …of our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to ... of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within specific guidelines… more
- Guardian Life (Augusta, ME)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...issues, when possible, to enhance the customer experience. **Activity** Review and assess claimant subjective reports and objective medical… more
- Central Maine Medical Center (Lewiston, ME)
- …plans, implements, and evaluates the needs of patients for discharge planning and utilization review . This includes those who may have Medicare, Medicaid, HMO, ... and significant others who have an ongoing caring relationship with the patient. Utilization review procedures include those stated for discharge planning in… more
- Central Maine Medical Center (Lewiston, ME)
- …to discuss and implement plans and progress of the department. *Participates in Utilization Management Committee, CQI, varying team meetings and other meetings ... clinical and leadership skills. Education and Experience: + BSN, RN , or LPN required. + 3-5 yrs. experience in...or LPN required. + 3-5 yrs. experience in healthcare management with direct reports Essential Duties: Leadership & Organizational… more
- Sedgwick (Augusta, ME)
- …to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Medicare Compliance **We are growing and looking for nurses who have their ... clinical data; to complete complex submissions revisions/updates in preparation for Medicare review and act as an internal resource regarding Centers for Medicare &… more