Utilization Review Nurse

The Utilization/Admission Review Coordinator promotes an effective continuum of care for the patient through intra- and interdepartmental utilization practices and coordination. Works with other departments to develop and maintain an effective integration of the revenue cycle functions to maximize reimbursement.

Minimum Education

• Graduate of an accredited school of nursing with BSN, preferred.

Minimum Work Experience

• 5 Years medical/surgical experience.
• Strong background in utilization management principles, concepts, and strategies, including admission criteria, observation, levels of care, and denials.

Required Licenses/Certifications

• Licensed in the State of Vermont.
• CPR Certification*

*Must obtain within 3 months of hire

Required Skills, Knowledge, and Abilities

• Excellent verbal and written communication skills.
• Demonstrated strong knowledge of basic computer skills.
• Skill with database management functionality.
• Understanding of commercial insurances, Medicare, Medicaid, and State/Federal regulatory frameworks that impact utilization.
• Strong working knowledge of insurance and regulatory terminology.
• Proven critical thinking and analytical skills.
• Strong organizational skills.
• Prior demonstration of attention to detail.
• Willingness and ability to participate in weekend coverage rotation.

Pay Range = $37.59 - $63.60

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