• RN Utilization Management

    Humana (Augusta, ME)
    **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... independent determination of the appropriate courses of action. The Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
    Humana (01/07/25)
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  • Mgr Utilization Review RN

    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....work experience + Hold a valid registration as a Registered Nurse As a health care system… more
    Baylor Scott & White Health (01/10/25)
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  • Clinical Manager Registered Nurse

    Fresenius Medical Center (Damariscotta, 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
    Fresenius Medical Center (01/10/25)
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  • Registered Nurse - Community Care…

    Veterans Affairs, Veterans Health Administration (Togus, ME)
    …is Full-Time at 40 hours per week. Responsibilities The Community Care (CC) Coordinator Registered Nurse ( RN ) is responsible for executing a streamlined ... Summary This Registered Nurse - Community Care Coordinator...intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards,… more
    Veterans Affairs, Veterans Health Administration (01/03/25)
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  • Registered Nurse II

    Northern Light Health (Ellsworth, ME)
    …or palliative care experience. Our Ellsworth region has a great position for a registered nurse wanting to make a positive difference in someone's life! You ... least 90 days (first time rehire only) Summary: The Registered Nurse II is a fully competent...the interdisciplinary team to maximize patient care. + Resource Management - Identifies opportunities to improve utilization more
    Northern Light Health (12/24/24)
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  • Registered Nurse II - Medical…

    Northern Light Health (Pittsfield, ME)
    …$10,000 (minus tax) sign on bonus that is paid out incrementally.** Summary: The Registered Nurse II is a fully competent practitioner of nursing. The incumbent ... Light Health Standards of Care/Practice, policies and procedures. The Registered Nurse II is responsible for the...the interdisciplinary team to maximize patient care. * Resource Management o Identifies opportunities to improve utilization more
    Northern Light Health (12/19/24)
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  • Registered Nurse II - Medical…

    Northern Light Health (Pittsfield, ME)
    …a $10,000 (minus tax) sign on bonus that is paid out incrementally. Summary:The Registered Nurse II is a fully competent practitioner of nursing. The incumbent ... Practice Act, Northern Light Health Standards of Care/Practice, policies and procedures. The Registered Nurse II is responsible for the delivery of patient care… more
    Northern Light Health (12/19/24)
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  • Registered Nurse II

    Northern Light Health (Presque Isle, ME)
    …Type: PRN Hours Per Week: 12.00 Work Schedule: 7:00 PM to 7:00 AM Summary: The Registered Nurse II is a fully competent practitioner of nursing. The incumbent is ... Light Health Standards of Care/Practice, policies and procedures. The Registered Nurse II is responsible for the...the interdisciplinary team to maximize patient care. + Resource Management - Identifies opportunities to improve utilization more
    Northern Light Health (01/07/25)
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  • Registered Nurse II - Emergency…

    Northern Light Health (Pittsfield, ME)
    …Work Type: PRN Hours Per Week: Variable Hours Work Schedule: Variable Summary: The Registered Nurse II is a fully competent practitioner of nursing. The ... Practice Act Northern Light Health Standards of Care/Practice, policies and procedures. The Registered Nurse II is responsible for the delivery of patient care… more
    Northern Light Health (01/07/25)
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  • Care Manager RN - Weekends (Remote)

    Highmark Health (Augusta, ME)
    …and Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
    Highmark Health (01/07/25)
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  • Clinical Registered Nurse - Remote

    Sharecare (Augusta, ME)
    …appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The RN is also responsible for ... and their Primary Care Provider according to the disease management program intervention guidelines. An RN is...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
    Sharecare (01/08/25)
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  • Care Manager Behavioral Health - Part Time…

    Highmark Health (Augusta, ME)
    …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES:** + Implement care management review processes that are consistent with established… more
    Highmark Health (12/12/24)
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  • Temporary Utilization Review

    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 ... retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use...and offerings. Education/Experience: + Unrestricted state license as a Registered Nurse required; BSN preferred. + 3+… more
    Martin's Point Health Care (01/08/25)
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  • Utilization Review Case Manager…

    Covenant Health (Bangor, ME)
    …of the VP of Accountable Care Operations & Population Health Strategy the Utilization Review Case Manager will work collaboratively with other members of ... the healthcare team. The nurse case manager also acts as an advocate for...Manager conducts medical necessity reviews in accordance with the Utilization Management (UM) plan for patients that… more
    Covenant Health (11/27/24)
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  • Care Manager RN

    Central Maine Medical Center (Rumford, ME)
    …+ Graduate of an accredited school of nursing with up to six (6) months of Registered Nurse experience. + Current RN license within the state of practice. ... plans, implements, and evaluates the needs of patients for discharge planning and utilization review . This includes those who may have Medicare, Medicaid, HMO,… more
    Central Maine Medical Center (01/07/25)
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  • Primary Care Team Coord/ RN

    Northern Light Health (Pittsfield, ME)
    …various data to trace potential causes and relevant details. Credentials + Required Registered Nurse Education + Required Associate's Degree Working Conditions + ... resource referrals as necessary. + Manage assigned case load, assessing utilization of resources and services, identifying patients that require additional … more
    Northern Light Health (10/22/24)
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  • RN Clinical Consultant, Claims Shared…

    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
    Guardian Life (12/20/24)
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  • Clinical Practice Manager RN - Family…

    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
    Central Maine Medical Center (12/06/24)
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