3 utilization management nurse jobs found

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...

A career at Auto-Owners is challenging and rewarding.  Our group of caring associates create financial security by helping individuals and businesses make a new start when a loss occurs. Job Description We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, this specific role could have the flexibility to work from home up to 3 days per week. Auto-Owners Insurance, a top-rated insurance carrier, is seeking motivated nursing professional to join our team. The position requires the person to: Use the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the claimant’s health across the care continuum. Coordinate care delivery and support among claimant support systems, including providers, community-based agencies, and family Collaborate with claims associates to provide medical expertise in the investigation, evaluation, and appropriate resolution of...

A career at Auto-Owners is challenging and rewarding.  Our group of caring associates create financial security by helping individuals and businesses make a new start when a loss occurs. Job Description We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, this specific role could have the flexibility to work from home up to 3 days per week. Auto-Owners Insurance, a top-rated insurance carrier, is seeking motivated nursing professional to join our team. The position requires the person to: ·        Collaborate with claims associates to provide medical expertise in the investigation, evaluation, and appropriate resolution of injury claims including workers’ compensation, personal injury protection (no fault), and liability. ·        Evaluate medical records for relatedness to the injury and appropriate utilization of medical treatment and services. ·        Prepare and deliver trainings to claims...