Utilization Management RN Specialist - Remote

Please note: This is a remote position that requires evening and weekend scheduling.

JOB SUMMARY:

The incumbent provides the clinical expertise and professionalism for implementing the Medical Center’s Utilization Management Program. The Utilization Management (UM) Specialist has well-developed knowledge and skills in areas of utilization management (UM), medical necessity, patient status determination, appeals and denials. This individual supports the UM program by developing and/or maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers. Utilization review on all assigned patients using technology and best practice standards. At the direction of the Utilization Management leadership, the incumbent is responsible for the overall completion and reporting of outcomes of medical record audits and will also work to defend and overturn clinical denials from private insurance carriers, Medicare and Medicaid, as directed. They are an essential link between the patient, the healthcare team, the payer, and the community.

EDUCATION:

State of Vermont Registered Nurse (RN) license required.

Case management accreditation required by a nationally recognized accrediting body for case management (examples: CCM, ACM or ANCC certifications), preferred.

EXPERIENCE:

Minimum of 3-5 years’ experience in a healthcare or clinical reviewer setting (or equivalent).

WHY UVM MEDICAL CENTER (UVMMC)?  

UVMMC is dedicated to our patients, providing the highest quality care for patients and their families. It is a mission that defines our culture, one of teamwork and collaboration. Every employee, whether they work directly in patient care or in a supporting role, has a hand in contributing to the wellness of the patient and the community.
  

BENEFITS:   
At UVMMC, we support our employees as passionately as we care for our patients. We offer a comprehensive, total compensation package that includes salary, health and wellness benefits, paid time off, and more.  

• https://www.uvmhealth.org/medcenter/health-careers/benefits   

LEARN MORE:    

• What is it like working here? https://www.uvmhealthnetworkcareers.org/diversity-equity-inclusion.html  

• Find more information about the University of Vermont Health Network here: https://www.uvmhealth.org/about-uvm-health-network