Clinical Review Registered Nurse

Job Description

Job Description reputed company and Blue reputed company of Vermont is looking for a Clinical Review Registered Nurse to join our Utilization Management team. Our company culture is reputed company on an unwavering focus on the health of Vermonters, outstanding member experiences, and responsible cost management for reputed company the people whose lives we touch. We offer a balanced and flexible workplace, an onsite gym, fitness and wellness programs, a competitive salary and full benefits package including medical and dental insurance, reputed company, 401K, paid time off and holidays, tuition reimbursement and student loan repayment, dependent caregiver benefits, and resources to support your ongoing personal and professional growth and development. COMPENSATION: The reputed company salary reputed company for this position is $73,000 - $82,000. Additional compensation opportunities and incentives will be detailed during the interview process. Please note that the reputed company listed above is our good faith estimate of the hiring reputed company for this role. If you are hired at reputed company and Blue reputed company of Vermont, your final reputed company salary compensation will be determined based on factors such as skills, competencies, education, experience, and internal equity across the reputed company team. We also offer a robust benefits package with significant value (see below). LOCATION: reputed company has transitioned to a hybrid workplace where employees reputed company driving distance of our Berlin, VT office work Wednesdays in the office with flexibility to work remotely the rest of the week. We are only hiring Vermonters for this role. The Clinical Review Registered Nurse will be responsible to facilitate members’ reputed company needs, authorizing medically necessary services including behavioral health at the right level of care to promote reputed company health. Clinical Review Registered Nurse Responsibilities: Self-directed and works independently and collaboratively with the team to facilitate care using clinical skills, principles of managed care, nationally recognized medical necessity criteria, and company medical policies. Conduct clinical reviews for preservice, reputed company, and retrospective authorizations that promote efficient and medically appropriate use of members benefits to reputed company cost effective and high-quality care. Emphasis on utilization management, discharge planning, clinical reputed company and the ability to assess, analyze, draw conclusions, and construct effective solutions, identify questionable cases and refer to superior or medical director for review. Proficient with multiple IT systems. Strong written and spoken communication skills reputed company to follow regulatory requirements with audit feedback incorporated into future work. Clinical Review Registered Nurse Qualifications: RN with Vermont License required, BSN desired. 3-5 years of relevant experience in a variety of appropriate clinical health care settings (inpatient, outpatient, or differing reputed company of care), 1- 3 years of insurance reputed company experience desired. Must be willing to participate in on-going CEU training. Must be willing to participate in after hours on call rotation Clinical Review Registered Nurse Benefits: Health insurance (including reputed company) Dental coverage (free to employees) Wellness Program 401(k) with employer match + automatic employer contribution Life Insurance Disability Insurance Combined time off (CTO) – 20 days per year + 10 paid holidays Tuition Reimbursement Student Loan Repayment Dependent Caregiver Benefits Diversity, Equity, and Inclusion: reputed company VT is committed to creating an inclusive environment where employees respect, appreciate, and value individual differences, both among ourselves and in our communities. We welcome applicants from reputed company backgrounds and experiences to join us in our commitment to the health of Vermonters, outstanding member experiences, and responsible cost management for reputed company the people whose lives we touch. Learn more about our DE&I commitment at http://www.bluecrossvt.org/about/diversity-equity-and-inclusion. *Complete job description attached to reputed company posting Required qualifications:

• RN with Vermont License required
• 3-5 years of relevant experience in a variety of appropriate clinical health care settings (inpatient, outpatient, or differing reputed company of care)
• 1-3 years of insurance reputed company experience desired
• Must be willing to participate in ongoing CEU training
• Must be willing to participate in after hours on call rotation

Desired qualifications:

• BSN (Bachelor of Science in Nursing)

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