Nurse Case Manager/Utilization Review Nurse II - Interim

State of Vermont • Waterbury, VT

2d • Hybrid

About The Position

The Department of Vermont Health Access (DVHA)'s Clinical Operations Unit (COU) is seeking a qualified registered nurse to join our dynamic team. This is an interim non-direct service position with an end date of 12/31/2026. The Interim Nurse Case Manager Utilization Review Nurse II is a professional role that will utilize clinical skills to help navigate the multifaceted healthcare system. This work utilizes many resources, such as clinical criteria, Medicaid Rule, and evidence-based standards. 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. 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.

Requirements

• Possession of (or eligible for) licensure as a Registered Nurse (RN) in Vermont OR eligible to practice in the state of Vermont via a multi-state license
• 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.
• Must maintain Vermont or multi-state licensure as a Registered Nurse as a condition of employment.
• Reliable means of personal transportation is required for work out of the office or in the community and field based settings.

Nice To Haves

• Bachelor of Science in Nursing (BSN).

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.

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level