Utilization Review RN- Onsite

Job Description

Company: The University of Vermont Health Network
Job Type: Onsite
Location: Champlain Valley Physicians Hospital (CVPH), Plattsburgh, NY
Salary: Competitive

General Summary:
The Utilization Review RN plays a crucial role in monitoring, collecting, and analyzing data to evaluate resource utilization, complications, and overall quality of care. By leveraging benchmarked criteria and established practices, the role aims to provide optimal care in a cost-effective manner. The position supports performance improvement, quality programs, risk management, and outcome measurement initiatives using guidelines from third-party payors and external agency review processes. The Utilization Review RN collaborates with internal and external resources to ensure appropriate resource management for a diverse patient population, identifying process improvement opportunities and working towards achieving positive outcomes.

Qualifications:

• Current New York State Registered Nurse license required.
• CCM Preferred.
• Three years of broad clinical nursing experience required.
• Quality assurance/risk management experience preferred.
• Experience with InterQual preferred. Knowledge of MCG a plus.
• Strong interpersonal, communication, and problem-solving skills required.
• Knowledge of insurance payment methodologies, coding, and regulations preferred.
• Familiarity with managed care processes and computer proficiency preferred.