Utilization Review Clinician

State of Vermont • Waterbury, VT • 1w ago

This job was posted by https://www.vermontjoblink.com : For more information, please see: https://www.vermontjoblink.com/jobs/1256991

Overview

Make a difference and work with a diverse team of professionals as a Utilization Review Clinician at the Department of Vermont Health Access (DVHA)! DVHA\'s Clinical Integrity Unit (CIU) is seeking a Utilization Review Clinician who will be responsible for ensuring that Vermont Medicaid members are receiving clinical services that are medically necessary and at the appropriate level of care.

\ Have the work/life balance you need with a Monday-Friday schedule and a supportive hybrid work environment requiring minimal travel. Eleven paid state holidays, in addition to a robust benefits package.

\ The Utilization Review Clinician position works within the DVHA Clinical Services Team (CST), which is a team of mental health clinicians, nurses, pharmacists, dentists, physicians, and administrative assistants. This position does not involve direct service or require travel.

\ The Utilization Review Clinician has the following responsibilities:\ Work to ensure that Vermont Medicaid members are receiving clinical services that are medically necessary and at the appropriate level of care.\ Performing utilization review for inpatient psychiatric hospitalization and other mental health services. Utilization review is done in accordance with accepted department criteria and Medicaid Rule.\ Collaborate with providers, facilities and various departments within the Agency of Human Services to guarantee that members are receiving services that are both appropriate and of high quality.\ Provides opportunities to participate in additional projects and clinical initiatives in which the Clinician can utilize their clinical skills and knowledge more broadly.

\ 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.\ \ Telework:\ The Department of Vermont Health Access (DVHA) supports a hybrid work environment. Upon hire, employees work with their supervisor to create a schedule that aligns with the business needs of the unit. We believe a hybrid work environment promotes autonomy and allows for increased flexibility and greater work/life balance.

Environmental Factors

Duties are performed largely in a standard office setting, but private means of transportation should be available for required travel outside of the office. Challenges occur on a regular basis involving obtaining appropriate services for discharge. Duties involve need for effective working relationships with a number of health care professionals.

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