Blue Cross Blue Shield of Michigan
Medical Review and Appeals RN - Human Organ Transplant Program (Healthcare)
Perform prospective, concurrent and retrospective review of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, appropriate length of stay, intensity of service and level of care, including appeal requests initiated by providers, facilities and members. May establish care plans and coordinate care through the health care continuum including member outreach assessments.
Preferences:
Utilization management preferred.
Excellent computer skills preferred.
Transplant
"Qualifications"
All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.