Clinical Review Registered Nurse

Clinical Review Registered Nurse

Regular Full-Time Berlin, VT, US

Salary Range: $73,000.00 to $82,000.00 annually.

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. The range listed above is our good faith estimate of the hiring range for this role. Final base salary will be determined based on skills, competencies, education, experience, and internal equity across the current team. We also offer a robust benefits package with significant value.

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.

As a Clinical Review Registered Nurse, you will facilitate members’ healthcare needs, authorizing medically necessary services including behavioral health at the appropriate level of care to promote optimal health.

Responsibilities:

• Conduct clinical reviews for pre‑service, concurrent, and retrospective authorizations that promote efficient and medically appropriate use of members benefits to provide cost effective and high‑quality care.
• Work 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.
• Emphasize utilization management, discharge planning, clinical outcomes, and the ability to assess, analyze, draw conclusions, and construct effective solutions, identify questionable cases and refer to a superior or medical director for review.
• Proficient with multiple IT systems.
• Strong written and spoken communication skills.
• Follow regulatory requirements with audit feedback incorporated into future work.

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.
• Willingness to participate in ongoing CEU training.
• Willingness to participate in after‑hours on‑call rotation.

Benefits:

• Dental coverage (free to employees).
• Wellness Program.
• 401(k) with employer match and 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 http://(Use the "Apply for this Job" box below)..