Utilization Review Nurse

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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