Clinical Review Registered Nurse
About The Position
Blue Cross and Blue Shield of Vermont is looking for a Clinical Review Registered Nurse to join our Utilization Management team. Our company culture is built on an unwavering focus on the health of Vermonters, outstanding member experiences, and responsible cost management for all 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, vision, 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. The Clinical Review Registered Nurse will be responsible for facilitating members’ healthcare needs, authorizing medically necessary services including behavioral health at the right level of care to promote optimal health.
Requirements
- RN with Vermont License required
- 3-5 years of relevant experience in a variety of appropriate clinical health care settings (inpatient, outpatient, or differing levels of care)
- Must be willing to participate in on-going CEU training.
- Must be willing to participate in after hours on call rotation
Nice To Haves
- BSN desired
- 1-3 years of insurance related experience desired
Responsibilities
- Conduct clinical reviews for preservice, concurrent, and retrospective authorizations that promote efficient and medically appropriate use of members benefits to provide cost effective and high-quality care.
- Self-directed, working 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.
- Emphasis on utilization management, discharge planning, clinical outcomes 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
- Able to follow regulatory requirements with audit feedback incorporated into future work.
Benefits
- medical and dental insurance
- vision
- 401K
- paid time off and holidays
- tuition reimbursement
- student loan repayment
- dependent caregiver benefits
- onsite gym
- fitness and wellness programs
- resources to support your ongoing personal and professional growth and development
- Health insurance (including vision)
- 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
