- 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 ... reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well… more
- Northern Light Health (South Portland, ME)
- …Portland Work Type: PRN Work Schedule: No Hours Assigned Summary: The Registered Nurse II is a fully competent practitioner of nursing. The incumbent is responsible ... 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
- Elevance Health (South Portland, ME)
- …responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by health care providers through prepayment ... claims review , post payment auditing, and provider record review...goals, policies and procedures. + Investigates potential fraud and over- utilization by performing the most complex medical reviews via… more
- First Atlantic Health Care (Saco, ME)
- …judgment, and critical thinking skill CERTIFICATES and LICENSES + Currently a registered nurse /licensed in Maine. + Certification upon hire or obtain it during ... policies, and procedures of the Nursing Services department. + Review and analyze facility activities and data to aid...and cash and risk management and to improve service utilization . + Prepare activity reports to inform management of… more