Clinical Review Registered Nurse

2 days ago


Montpelier, Vermont, United States BlueCross BlueShield of Vermont Full time
Job Opportunity

Blue Cross and Blue Shield of Vermont is seeking a skilled Clinical Review Registered Nurse to join our Utilization Management team. As a key member of our team, you will play a critical role in ensuring the delivery of high-quality, cost-effective care to our members.

Key Responsibilities:

  • Conduct thorough clinical reviews to determine medical necessity and appropriateness of services.
  • Identify and address potential issues or concerns through collaboration with medical directors and other stakeholders.
  • Develop and maintain expertise in clinical review processes and guidelines.

Requirements:

  • RN with Vermont license required; BSN desired.
  • 5-7 years of clinical practice experience.
  • 1-3 years of insurance-related experience desired.
  • Ability to participate in ongoing CEU training.

Benefits:

  • Competitive salary and comprehensive benefits package.
  • Opportunities for professional growth and development.
  • Flexible work arrangements, including remote work options.


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