Clinical Review Registered Nurse

3 hours ago


Berlin Corners, Vermont, United States BlueCross BlueShield of Vermont Full time

Blue Cross and Blue Shield of Vermont is seeking a Clinical Review Registered Nurse to join our Utilization Management team.

We are committed to delivering high-quality, cost-effective care to our members. As a Clinical Review Registered Nurse, you will play a critical role in ensuring that our members receive the necessary care while minimizing unnecessary costs.

Key Responsibilities:

  • Execute utilization management processes to ensure the delivery of medically necessary and appropriate care.
  • Review requests against standardized medical necessity and appropriateness criteria.
  • Identify questionable cases and refer to a superior or medical director for review.

Requirements:

  • RN with Vermont License required; BSN desired.
  • 7 years of clinical practice required.
  • 1-3 years of insurance-related experience desired.

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

We offer a balanced, flexible workplace, an onsite gym, fitness and wellness programs, a competitive salary and full benefits package.

Applicants must reside in Vermont.

Remote work options are available for this role.



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