Clinical Review Registered Nurse

Job Description

Job Description

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.

COMPENSATION: The base salary range for this position is $73,000 - $82,000. Additional compensation opportunities and incentives will be detailed during the interview process. Please note that the range listed above is our good faith estimate of the hiring range for this role. If you are hired at Blue Cross and Blue Shield of Vermont, your final base salary compensation will be determined based on factors such as skills, competencies, education, experience, and internal equity across the current team. We also offer a robust benefits package with significant value (see below).

LOCATION: Blue Cross has transitioned to a hybrid workplace where employees within 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. Standard work hours are 8:00-4:30.

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.

Clinical Review Registered Nurse 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.

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 levels of care),
• 1- 3 years of insurance related 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 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

Diversity, Equity, and Inclusion: Blue Cross 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 all backgrounds and experiences to join us in our commitment to the health of Vermonters, outstanding member experiences, and responsible cost management for all the people whose lives we touch. Learn more about our DE&I commitment at -equity-and-inclusion.

*Complete job description attached to ADP posting

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