- Covenant Health (Bangor, ME)
- …the supervision 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... conducts medical necessity reviews in accordance with the Utilization Management (UM) plan for patients that are housed… more
- Baylor Scott & White Health (Augusta, ME)
- …Note: Benefits may vary based on position type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff. You oversee ... members. **Key Success Factors** + Demonstrable knowledge in discharge planning, case management, utilization review and different care levels. + Outstanding… more
- Sunrun (Augusta, ME)
- …in through our commitment to diversity, inclusion and belonging. **Overview** The O&M Case Manager is responsible for coordinating effective execution of field ... and develop partner or branch relationships including weekly/monthly reviews, utilization and workload management, process updates and identification and resolution… more
- United Therapeutics (Augusta, ME)
- …to meet the needs of the intended audience and contributors + End-to-end case processing, including data entry, QC, medical review , and regulatory submissions ... with superior financial performance and our communities with earth-sensitive energy utilization . Our company was founded by an entrepreneur whose daughter was… more
- Highmark Health (Augusta, ME)
- …Remote - Part Time - Weekends Required.** This job implements the effective utilization management strategies including: review of appropriateness of health care ... services, application of criteria to assure appropriate resource utilization , identification of opportunities for referral to a Health Coach/ case management, and… more
- Highmark Health (Augusta, ME)
- …Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care ... services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/ case management, and… more
- Central Maine Medical Center (Rumford, ME)
- …plans, implements, and evaluates the needs of patients for discharge planning and utilization review . This includes those who may have Medicare, Medicaid, HMO, ... who have an ongoing caring relationship with the patient. Utilization review procedures include those stated for...Documentation meets current standards and policies. + Cooperates with Case Manager 's activities with the insurance company,… more
- Central Maine Medical Center (Lewiston, ME)
- …approach. + Works with other key individuals, including the Program Manager , Director(s) or Provider(s) in identifying, developing, implementing, and monitoring ... Assists in the development and implementation of policies and procedures, including review . Follows HIM policy related to medical record release, informed consent,… more
- Nelnet (Augusta, ME)
- …in territory by reviewing client contracts, maintaining contract end dates, championing utilization , and proactively engaging clients to extend/ review the term ... for people where they live, learn and work. The Manager - Account Executives - Sales - NCC -...one time per year to deliver an annual account review communicating Nelnet's value and long-range planning objectives. 9.… more
- Northern Light Health (Bangor, ME)
- …being referred for admission and Hospital Outpatient Services. He/she presents case information to Clinical, Psychiatric and Nursing staff; schedules evaluations and ... after-hours back up to multiple Acadia departments including Registration, Utilization Management, Facilities, Ambulatory Clinic Scheduling and the Narcotic… more
- Elevance Health (South Portland, ME)
- …or regulation, must be in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.… more
- Elevance Health (South Portland, ME)
- …the medical necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts ... + Extensive orthopedic surgery experience preferred. + Experience with utilization management, especially with CMS guidelines preferred. For candidates working… more
- Elevance Health (South Portland, ME)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.… more
- Honeywell (ME)
- …and service. You will report directly to our Sr Field Service Engineering Manager . KEY RESPONSIBILITIES + Being single point of contact/customer focal of assigned ... Manage and document customer communications via SFDC and own case closure + Routing and escalation of technical issues...issues + Participate in weekly CCT/CBM meetings and quarterly review sessions with the customer + Maintain ownership of… more