Nurse Case Manager/Utilization Review Nurse II - Interim

State of Vermont • Waterbury, VT • 1h ago

This job was posted by https://www.vermontjoblink.com : For more information, please see: https://www.vermontjoblink.com/jobs/1373007

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.

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.

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