- 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Baylor Scott & White Health (Augusta, ME)
- …and members. **Key Success Factors** + Demonstrable knowledge in discharge planning, case management , utilization review and different care levels. + ... type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff.... management , and budget control. Departments involved are Utilization Management , Case Management , and… 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 VA offers a comprehensive total rewards package: VA Nurse Total Rewards This Registered Nurse - Community...Set (MDS) coordinator to ensure accuracy of the Resource Utilization Group (RUG) score. Included but are not limited… more
- Evolent (Augusta, ME)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more
- Evolent (Augusta, ME)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and client policies and ... behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … 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
- Intermountain Health (Augusta, ME)
- …of 2 years' experience in acute clinical nursing setting + Knowledge of utilization management and case management principles preferred KNOWLEDGE, SKILLS, ... **Job Description:** The Pre-Access Prior Authorization RN provides timely review of authorization requests and/or review of denials to ensure medical necessity,… more