Utilization Review Nurse
The University of Vermont Health Network
POSITION SUMMARY
The Utilization Review Nurse is responsible for ensuring the medical necessity and appropriate level of care of all hospital admissions and extended hospital stays, including psychiatry; affirming compliance with CMS’ Conditions of Participation regarding Utilization Management with annual review of the UM Plan and assisting with the coordination of the Utilization Management Committee; Knowledge of CMS policy, guidance and criteria as well as those of various managed care insurance plans.
MINIMUM REQUIREMENTS
Nursing Degree, LPN, RN, BSN, MSN with acute or outpatient healthcare setting experience. Equivalent degree with acute or outpatient healthcare setting experience considered on case by case basis. Current RN or LPN licensure or compact licensure recognized by the State of Vermont is required.
PRIOR EXPERIENCE
3-5 years acute care hospital nurse and/or
3-5 years chart review, prior authorizations, managed care, familiarity of clinical documentation requirements