Nurse Case Manager/Utilization Review Nurse II - Interim
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. 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. 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.
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. This work utilizes many resources, such as clinical criteria, Medicaid Rule, and evidence-based standards.
Benefits
- 80% State paid medical premium
- Dental plan at no cost for employees and their families
- 11 paid holidays each year
- Generous leave plan
- State Paid Family and Medical Leave Insurance (FMLI)
- State defined benefit pension plan
- 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
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
