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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
State of Vermont Registered Nurse (RN) license required. The University of Vermont Health Network is moving toward an all Bachelor of Science in Nursing (BSN) workforce.
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
