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 our members and giving them the best service possible. 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.
COVID-19: Blue Cross is requiring all employees and covered consultants to be fully vaccinated (including first booster if eligible) against COVID-19 and provide proof of vaccination as of January 1, 2022. Those with a medical condition or sincerely held religious belief preventing them from being vaccinated can request an exemption without fear of retaliation or an impact on job candidacy.
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.
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 + 9 paid holidays
• Tuition Reimbursement
• Student Loan Repayment
• Dependent Caregiver Benefits

• Complete job description attached to ADP posting

Job Type: Full-time

Pay: $68,000.00 - $72,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Supplemental pay types:

• Bonus pay

Work Location: Hybrid remote in Barre, VT 05641

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