![BlueCross BlueShield of Vermont](https://media.trabajo.org/img/noimg.jpg)
Clinical Review Registered Nurse
4 weeks ago
Blue Cross and Blue Shield of Vermont is looking for a Clinical Review Registered Nurse to join our Brand & Engagement Strategies team. Our company 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, 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.
REMOTE WORK: 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. Applicants must reside in Vermont.
Clinical Review Registered Nurse Responsibilities:
- Execute utilization management processes to ensure the delivery of medically necessary and appropriate, cost effective and high-quality care through the performance of clinical reviews.
- Review requests against standardized medical necessity and appropriateness criteria for an initial and a continued service authorization.
- Identify questionable cases and refer to superior or a medical director for review.
Clinical Review Registered Nurse Qualifications:
- RN with Vermont License required; BSN desired.
- 5 – 7 years of clinical practice required.
- 1- 3 years of insurance related experience desired.
- Must be willing to participate in on-going CEU training.
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
*Complete job description attached to ADP posting
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