Nurse Case Manager/Utilization Review Nurse II - Interim

Overview

The Department of Vermont Health Access (DVHA)'s Clinical Operations Unit (COU) is seeking a qualified registered nurse to join our dynamic team. Work in a supportive work environment with a Monday - Friday schedule, paid holidays, in addition to a robust benefits package. This is an interim non-direct service position with an end date of: 12/31/2026.

The Interim Nurse Case Manager Utilization Review Nuse II is a professional role that will utilize clinical skills to help navigate the multifaceted healthcare system. This role has the following responsibilities:
• Reviewing clinical documentation to determine medical necessity, recommendations of service authorizations, medical adherence, and/or to identify potential gaps in knowledge and provide necessary education.
• Utilization review to identify health care patterns and recommend policy changes or clinical practice standards to improve health outcomes and minimize inappropriate utilization.
• Participation with quality assurance and quality improvement projects within the COU or in collaboration with other Units in DVHA.
This work utilizes many resources, such as clinical criteria, Medicaid Rule, and evidence-based standards.


Mission:
The Department of Vermont Health Access (DVHA)'s mission is to improve Vermonters' health and well-being by providing access to high-quality, cost-effective health care. We have identified three priorities that support our mission: Advancing value-based payments, modernizing information technology infrastructure, and operational performance improvement. Our department commits to executing our responsibilities and priorities while adhering to three core values: Transparency, Integrity and Service.

Diversity, Equity, and Inclusion:
As part of our values of transparency, integrity, and service, we are committed to supporting diversity, equity, inclusion, and accessibility as part of our person-centered culture. We actively celebrate our colleagues' and future colleagues' different abilities, racial identity, sexual orientation, ethnicity, age, and gender. Everyone is welcome and supported here.

Our State:
Vermont is a "small but mighty" state. We are ranked as one of the top 10 states to raise a family in 2022. We are nationwide leaders for progressive social and educational policies. We are in Northern New England, 1.5 hours from Montreal and 3.5 hours from Boston. We have beautiful Lake Champlain, the Green Mountains, and year-round outdoor activities.

Who May Apply

This position, Nurse Case Manager/Utilization Review Nurse II - Interim (Job Requisition #55154) , is open to all State employees and external applicants.
If you would like more information about this position, please contact View email address on click.appcast.io
Resumes will not be accepted via e-mail. You must apply online to be considered.
Please note that multiple positions in the same work location may be filled from this job posting.

AHS BACKGROUND CHECKS: Candidates must pass any level of background investigation applicable to the position. In accordance with AHS Policy 4.02, Hiring Standards, Vermont and/or national criminal record checks, as well as DMV and adult and child abuse registry checks, as appropriate to the position under recruitment, will be conducted on candidates, with the exception of those who are current classified state employees seeking transfer, promotion or demotion into an AHS classified position or are persons exercising re-employment (RIF) rights.

Environmental Factors

Duties are performed in a standard office setting and/or in the community. Extensive travel may be required, for which private means of transport must be available. Certain functions may require duty outside of normal work hours. Some resistance or objection to standards may be anticipated, requiring tact and diplomacy to achieve proper action. Duties involve need for effective communication and working relationships with a diverse group of stakeholders, including the individual, family members and a number of health care disciplines and service providers; and operational integration with various other health care reform initiatives supported by AHS. Program issues may require difficult choices among resources available and health care needs. Critical assessment skills are necessary to promote personal and client safety.

Minimum Qualifications

Possession of (or eligible for) licensure as a Registered Nurse (RN) in Vermont OR eliglbe to practice in teh state of Vermont via a multi-state license AND five (5) years or more of professional nursing experience in an acute hospital setting, long term care, health insurance carrier, or within a community health/public health setting.

NOTE: Must maintain Vermont or multi-state licensure as a Registered Nurse as a condition of employment.

Preferred Qualifications

Bachelor of Science in Nursing (BSN).

Special Requirements

Reliable means of personal transportation is required for work out of the office or in the community and field based settings.

Total Compensation

As a State employee you are offered a great career opportunity, but it's more than a paycheck. The State's total compensation package features an outstanding set of employee benefits that are worth about 30% of your total compensation, including:

• 80% State paid medical premium and a dental plan at no cost for employees and their families
• Work/Life balance: 11 paid holidays each year and a generous leave plan
• State Paid Family and Medical Leave Insurance (FMLI)
• Two ways to save for your retirement: A State defined benefit pension plan and a deferred compensation 457(b) plan
• Tuition Reimbursement
• Flexible spending healthcare and childcare reimbursement accounts
• Low cost group life insurance
• Incentive-based Wellness Program
• Qualified Employer for Public Service Student Loan Forgiveness Program

Want the specifics? Explore the Benefits of State Employment on our website.

Equal Opportunity Employer

The State of Vermont celebrates diversity, and is committed to providing an environment of mutual respect and meaningful inclusion that represents a variety of backgrounds, perspectives, and skills. The State does not discriminate in employment on the basis of race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, membership in an employee organization, family medical history or genetic information, or family or parental status. The State's employment decisions are merit-based. Retaliatory adverse employment actions by the State are forbidden.