NewPhysician Coding Auditor Ensemble Health PartnersPhysician Coding AuditorSanford, ME$57,400–$99,000The Physician Coding Auditor develops and implements strategic needs analyses and training plans for coding leadership; coordinates and evaluates curriculum development and conducts the preparation and delivery of training for Medical Coders employed by Ensemble and providers that are contracted/employed and outlined in the client SOW. Educating - Assesses the educational needs of coding staff and providers that are contracted/employed and outlined in the client SOW (included Provider Education verbiage) and develops programs or researches educational resources to meet those needs.
NewMedical Billing Specialist-Accounts Receivable New England Cancer SpecialistsMedical Billing Specialist-Accounts ReceivableWestbrook, MEYou are responsible for the full accounts receivable life cycle, including analyzing and researching unpaid claims, assisting in the resolution of denials, partial payments, and over-payments as well as communicating with payers, patients and other team members. Identify and resolve denials and improper payments by accessing payer web applications, completing forms and telephoning account representative per New England Cancer Specialists policies.
Special Investigation Unit (SIU) Manager CVS Health CorpSpecial Investigation Unit (SIU) ManagerME$54,300–$159,120 / yearThe Certified Professional Coder (CPC) Manager will oversee a team of medical coders within the Special Investigations Unit (SIU) to ensure compliance with coding practices through comprehensive record reviews for medical, behavioral, transportation, and other healthcare providers. Ensure staff provide detailed written summaries of medical record review findings and ensure the team articulates findings effectively to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, and state regulators.
Practice Manager - Sanford & Saco, ME ConvenientMDPractice Manager - Sanford & Saco, MESanford, MaineDual-site management experience: Proven ability to successfully oversee operations across multiple clinic locations, balancing priorities, optimizing workflows, and ensuring consistent team performance and patient experience at each site. As a dual Practice Manager at both our Sanford & Saco, Maine urgent care clinics, you will play a pivotal role in the day-to-day operational efficiency of the clinics while contributing to their long-term strategic goals.
Care Management Associate, Engagement Hub CVS Health CorpCare Management Associate, Engagement HubME$18.50–$31.72 / hourStrong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members, adhering to care management processes (to include, but not limited to, privacy and confidentiality, quality management processes in compliance with regulatory, accreditation guidelines, company policies and procedures). Aetna's Medicaid Care Management Engagement Outreach Hub is a new initiative focused on prioritizing Medicaid member interaction, maximizing inbound and outbound touchpoints to solve members' needs and create behavioral change.
Business Development Executive (MedInsight) Milliman IncBusiness Development Executive (MedInsight)Portland, MERemote$120,635–$199,065 / yearMedInsight is a subsidiary of Milliman; a global, employee-owned consultancy providing actuarial consulting, retirement funding and healthcare financing, enterprise risk management and regulatory compliance, data analytics and business transformation as well as a range of other consulting and technology solutions. Primary Responsibilities: Develop deep expertise in MedInsight's risk adjustment software and analytics, and in the surrounding market (CMS-HCC models, RADV, quality programs, value-based care, and the competitive landscape) to engage prospects as a credible advisor.
VP Pharmacy Services Martin's Point Health Care LLCVP Pharmacy ServicesPortland, MEDirects the full scope of pharmacy operations, including formulary management, prior authorizations, formulary exceptions, medication adherence, patient accounting, billing practices, vendor billing oversight, and daily systems operations to ensure efficient, effective, and high-quality service delivery. Partners collaboratively across Pharmacy, Finance, Nursing, Medicine, Population Health, Practice, and other MPHC divisions to align clinical, administrative, and business processes, support patient-centered care, and promote appropriate prescribing, documentation, coding, reconciliation, and reimbursement practices.
Field Reimbursement Manager - Kidney (New England - ME, VT, NH, MA, RI, CT) Vertex Pharmaceuticals IncField Reimbursement Manager - Kidney (New England - ME, VT, NH, MA, RI, CT)ME$136,000–$204,000 / yearKey Duties and Responsibilities: Compliantly establish strong connections with key nephrology office personnel, including members of the care team and administrative staff responsible for prior authorizations and patient access to specialty medications, to support patient access to prescribed medications. At Vertex, our Total Rewards offerings also include inclusive market-leading benefits to meet our employees wherever they are in their career, financial, family and wellbeing journey while providing flexibility and resources to support their growth and aspirations.
*Registered Nurse Centralized Services - Hybrid after onsite training in Portland - $2,000 sign-on bonus! Martin's Point Health Care LLC*Registered Nurse Centralized Services - Hybrid after onsite training in Portland - $2,000 sign-on bonus!Portland, MEKnowledge Knowledge of healthcare operations, especially in a primary care setting Knowledge of quality measures and how to improve patient outcomes through quality gap closure Understanding or interest in expanding knowledge of clinical quality measures (HEDIS) and coding concepts (CPT, ICD10, and HCC) preferred Understanding of EHR documentation and quality reporting preferred. Skills Strong critical thinking, problem-solving, and project management skills Exceptional organizational, written and verbal communication, and attention to detail skills Computer proficiency in Microsoft Office software Proficient in working within an electronic medical record (EMR).
Senior Investigator, Special Investigations Unit (Aetna SIU) CVS Health CorpSenior Investigator, Special Investigations Unit (Aetna SIU)ME$46,988–$122,400 / yearAnticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $46,988.00 - $122,400.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations of fraud and abuse Required Qualifications 3 years working on health care fraud, waste, and abuse investigatory and audits required.
Medical Director - ENT CVS Health CorpMedical Director - ENTME$174,070–$374,920 / yearLeads all aspects of utilization review/quality assurance, directing case management Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams Responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Medical Receptionist ConvenientMDMedical ReceptionistWestbrook, MaineWorking alongside the clinical team, you will be responsible for greeting patients and visitors, completing patient registration, updating new and existing patient records, collecting payment, and ensuring patients with or without pre-existing reservations are seen in a timely manner. To support this belief, we’re building a team of dedicated professionals who genuinely care about improving lives, are passionate about work that can make a difference, and are driven to learn from one another.
Care Manager RN - Per Diem UnitedHealth Group IncCare Manager RN - Per DiemPortland, MEIreland & UK ›India ›Philippines ›Culture of Belonging›Employee Benefits›BlogJob seeker resources Login Bookmarked jobs 0 Career areas Clinical PhysiciansAdvanced practice cliniciansPharmacyBehavioral healthNursingMedical codingClinical support Corporate and business operations Administrative supportConsultingFinance and business analyticsLegal and complianceMarketing and communicationsPeople teamProject management Customer and support services BillingClaimsCustomer ServiceData entryEarly careers Sales and account management Account managementSalesSales management Technology and data Artificial intelligenceArchitectureBusiness systems analysisData analyticsData engineeringData scienceNetwork infrastructureProduct management & developmentSecurity and riskSoftware engineering Life here U.S. Culture of BelongingEmployee BenefitsMilitary Fellowship Program Ireland & UK Culture of BelongingEmployee Benefits India Culture of BelongingEmployee Benefits Philippines Culture of BelongingEmployee BenefitsJoin our talent communityOpen search formKeyword or job numberLocationGoExplore remote jobsPursue your passion and potentialCare Manager RN - Per Diem Portland Maine Apply Internal apply Bookmark job Jump to Our values Job description Benefits Testimonial Awards & recognitions Related content Caring. serves as an educational resource to all Health System staff regarding utilization reviewAssumes roles in assessment physical psychosocial & economic needs for transition of care planning to a variety of levels of care delegates to others as appropriateDocuments verifies and validates specific data required to monitor and evaluate interventions and outcomesInterviews and collects patient specified data and chart review related to readmission and appropriately notifies care teamCommunicates telephonically and electronically with outpatient providers to enhance the continuum of careIntegrates performance improvement principles and customer service excellence principles into all aspects of job responsibilities practice and governmental commercial payer guidelinesAdheres to the policies procedures rules regulations and laws of the hospital and all federal and state regulatory bodiesAssume responsibility for Health System required continued education and owns professional growthPerforms tasks of a clinical nature within scope of assigned duties and clinical expertiseCommunicate effectively in both oral and written form as appropriate for the needs of the audiencePerforms other duties as assigned or requiredYoull be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
NewSenior Software Development Engineer CVS Health CorpSenior Software Development EngineerME$83,430–$222,480 / yearCVS Health Digital is looking for hands-on, passionate people who want to join a high energy and growing team to make a difference in customers' lives and who want to be on the forefront of digital innovation that aims to reinvent what a pharmacy and a health care company can be in the digital world. Currently, we are seeking a Senior Software Development Engineer with deep expertise in Java/JEE, Spring Boot, RESTful microservices, and Kafka to lead the design and development of scalable, secure cloud-native solutions.
NewMedical Director - Radiation Oncology - MD or DO CVS Health CorpMedical Director - Radiation Oncology - MD or DOME$174,070–$374,920 / yearThe Radiation Oncology Medical Director supports the CVS Health Specialty oncology business in managing oncology specific utilization of providers, clinical reviews of oncology specific data, and assist with growing our oncology footprint. In the Medical Director role, you will provide oversight for medical policy implementation; you will support the ensuring timely and consistent responses to members and providers; you will focus on prior authorization cases and consultation cases.
Nurse Practitioner (Per Diem) ComplexCare SolutionsNurse Practitioner (Per Diem)Sanford, Maine$2,400–$10,000 / yearPer diemAbility to practice autonomously in a remote clinical environment, including independently conducting patient assessments, formulating evidence-based treatment plans, managing complex chronic conditions, and making sound clinical decisions without direct on-site supervision. Pay Range: $2,400.00 - $10,000.00 per month (Potential income) Earnings will vary based on completed assessments, state of residence, and business needs as there is no guarantee of visits or minimum income.
Staff Development Engineer - Fulfillment CVS Health CorpStaff Development Engineer - FulfillmentME$106,605–$284,280 / year7+ years of software development in enterprise / web / cloud applications • 5+ years of backend software development experience with programming languages/tools including: Java, Spring Boot, Kafka • 3+ years of distributed caching experience • 3+ years of experience having a track record developing in AWS or GCP or Azure or similar public cloud environments (GCP preferred) • 3+ years of experience in design, development and operationalizing microservices based web/webservices application in cloud native environment • 3+ years of technical lead experience within a matrixed environment, including mentoring junior engineers and working cross collaboratively between architecture, product, etc. • Understand security threats and patterns and ensure adherence to all regulatory initiatives, HIPAA, PHI, PII, locational and contractual data restrictions • Experience with build automation technologies like Maven, Gradle, Jenkins, Harness • Expert knowledge with functional, imperative and object-oriented languages and methodologies • Experience with Cassandra and Postgres - preferred • Experience with test-driven development and automated testing frameworks • Experience with Scrum/Agile development methodologies.
Staff Software Development Engineer CVS Health CorpStaff Software Development EngineerME$106,605–$284,280 / yearFurthermore, the Staff Engineer role includes closely working with a team of engineers to drive delivery excellence, partner with business and other IT leaders to build digital assets, provide expert level support to resolve complex issues and provide RCA, identify gaps in systems in current digital eco system and provide solutions to enhance overall performance. CVS Health Digital is looking for hands-on, passionate people who want to join a high energy and growing team to make a difference in customers' lives and who want to be on the forefront of digital innovation that aims to reinvent what a pharmacy and a health care company can be in the digital world.