1 utilization management nurse jobs found in Detroit, MI

Coordination of all activity associated with the development and maintenance of medical policy and benefit interpretation in accordance with BCN certificates, riders, waivers, statewide policies and with BCBSM policies and procedures.  Investigation of new procedures, technology, drugs and devices.  Maintenance of clinical documentation related to new technologies and treatment modalities, including BCN's position of coverage of these items/services/treatments.  Communication to and education of team members, including physician advisors regarding new technologies, treatment modalities, drugs and devices with an emphasis/focus on BCN's policy and benefit determination. Coordination of all requests related to solid organ transplants (other than kidney, skin and cornea) and for bone marrow transplants, as well as for services that are potentially experimental or investigational. Proactively identify and evaluate documentation on new treatments and technologies for potential...