Vermont Licensed Clinical Review Nurse

Job Summary

A company is looking for a Clinical Review Registered Nurse.

Key Responsibilities:

• Conduct clinical reviews for prior approval, post-service reviews, and claim requests
• Determine the adequacy of clinical information and communicate with providers for additional data as needed
• Perform audits and provide timely reviews for procedure/service appropriateness based on established guidelines

Required Qualifications:

• 5+ years of clinical/hospital experience as a Registered Nurse
• Compact Nursing License required
• 2+ years of Utilization Review/Management experience
• Experience with medical policy and evidence-based guidelines
• Ability to perform timely case reviews and updates in appropriate systems