Vermont Licensed Clinical Review RN

Job Summary

A company is looking for a Clinical Review Registered Nurse.

Key Responsibilities:

• Conduct clinical reviews of prior approval, post-service reviews, and claim requests
• Communicate with providers to obtain necessary clinical information for utilization management decisions
• Perform audits and provide timely reviews for service appropriateness based on established standards

Required Qualifications:

• Active Vermont RN License
• Experience in utilization management and clinical review processes
• Knowledge of medical policy and evidence-based guidelines
• Ability to perform audits and case reviews accurately
• Experience in provider relations and clinical issue resolution