- Kepro (Portland, ME)
- …regulatory bodies, you'll play a pivotal role in upholding industry benchmarks. This full-time Clinical Reviewer Remote position based in the state of Maine. ... solutions in the public sector. Acentra seeks a Utilization Clinical Reviewer to join our growing team....the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process. Adhering rigorously to standards set by NCQA,… more
- Elevance Health (South Portland, ME)
- …a hybrid model ( remote and office). The ideal candidate must live within 50 miles of our Elevance Health PulsePoint location listed in the requisition.** **Work ... ** Clinical Fraud Investigator II** **Location: This position will...opportunities for fraud and abuse prevention and control. + Review and conducts analysis of claims and dental medical… more
- Elevance Health (South Portland, ME)
- ** Clinical Fraud Investigator II - SIU Fraud &...remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health ... Workplace Strategy:** 1-2 days in office per week The ** Clinical Fraud Investigator II** is responsible for identifying issues...opportunities for fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records… more
- Elevance Health (South Portland, ME)
- **Title: Grievance/Appeals Analyst I** **Location:** This position will work a hybrid model ( remote and office). Ideal candidates will live within 50 miles of ... determination. + Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical … more
- Elevance Health (South Portland, ME)
- …a hybrid model ( remote and office). The ideal candidate will live within 50 miles from our Elevance Health Pulse Point locations._ Carelon Payment Integrity is ... fraudulent activities by health care providers through prepayment claims review , post payment auditing, and provider record review...AS in nursing and minimum of 5 years of clinical experience and minimum of 2 years of claims… more
- Elevance Health (South Portland, ME)
- …- Safety and Epidemiology Research** **Location:** This position will work a hybrid model ( remote and in office one day per week). Ideal candidates will live ... within 50 miles of one of our Pulse Point...and communicates requirements to the programming group. + Conduct review of administrative claims data and statistical output to… more