Clinical Review Registered Nurse

About the role

Blue Cross and Blue Shield of Vermont is seeking a Clinical Review Registered Nurse to join their Utilization Management team. The company focuses on the health of Vermonters, excellent member experiences, and responsible cost management.

Responsibilities

• Conduct clinical reviews for preservice, concurrent, and retrospective authorizations to ensure efficient and medically appropriate use of members' benefits.
• Facilitate care using clinical skills, principles of managed care, nationally recognized medical necessity criteria, and company medical policies.
• Work independently and collaboratively with the team to manage care, including discharge planning and clinical outcomes.
• Assess, analyze, and construct effective solutions for questionable cases, referring to superior or medical directors as needed.
• Be proficient with multiple IT systems and possess strong written and spoken communication skills.
• Able to follow regulatory requirements and incorporate audit feedback into future work.

Qualifications

• RN with a Vermont license required, BSN preferred.
• 3-5 years of relevant experience in various clinical health care settings (inpatient, outpatient, or differing levels of care).
• 1-3 years of insurance-related experience desired.
• Willingness to participate in ongoing CEU training.
• Willingness to participate in after-hours on-call rotation.

Benefits

• 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
• Tuition reimbursement
• Student loan repayment
• Dependent caregiver benefits

Pay

The base salary range for this position is $73,000 - $82,000. Additional compensation opportunities and incentives will be detailed during the interview process.

Schedule

Standard work hours are 8:00-4:30. Employees within driving distance of the Berlin, VT office work Wednesdays in the office with flexibility to work remotely the rest of the week.