Title: Nurse Case Manager/Utilization Review Nurse I
Morrisville, VT, US
Overview
The Department of Vermont Health Access (DVHA)'s mission is to improve the health and well-being of Vermonters by providing access to quality healthcare cost effectively. We have three priorities that support us in moving our mission forward: Adoption of value-based payments, management of information technology projects, and operational performance improvement. Our department commits to executing our responsibilities and priorities while adhering to three core values: Transparency, Integrity and Service.
DVHA's Vermont Chronic Care Initiative (VCCI) Unit is seeking a qualified individual to join their dynamic team.
The population of Vermonters served by VCCI includes at risk and high-risk individuals with complex health and health related needs, as well as outreach to members new to the state health plan for screening and facilitation to health and health related services. VCCI clinical case management services are delivered through implementing the Complex Care Model, utilizing patient engagement tools, and working with care teams and a shared plan of care. The goals of VCCI case management services are to ensure individuals have a medical home, are accessing appropriate health services, receive evidence-based care and have the skills and confidence to self-manage their own health, which ultimately will reduce ambulatory sensitive hospitalizations and emergency department visits. VCCI also needs to ensure individuals have access to services that will meet their health-related needs such as housing, food, transportation, and employment. Using a holistic approach and motivational interviewing skills, the nurse works with the individual as part of a multidisciplinary team including providers, state agencies, community service providers, hospitals, Blueprint Community Health Team members, mental health/behavioral health and substance abuse treatment providers and other stakeholders to facilitate and assure an effective clinical plan of care that supports overall health improvement and connectedness to their community. The nurse uses approved clinical assessment/screening tools to identify service needs as well as gaps in care, establish a priority-based plan of care in partnership with the individual and primary care provider and implements the clinical plan of care based on evidence-based standards, program goals/metrics and health plan rules, with input as needed/appropriate from the VCCI Manager and oversight by the Chief Medical Officer. Work will be performed in the community (in person visits) and may be performed in the office +/or on virtual platforms and provider practices or other community settings depending on the area of clinical assignment. This position primarily covers Lamoille County, but flexibility to cover other counties may be requested. Travel to in person visits, off-site appointments and meetings should be anticipated for which a private means of transportation is required. Computer proficiency including Microsoft Office programs is needed, Professional communication and Organizational skills are necessary.
Monday- Friday schedule; no on call hours.
Who May Apply
This position, Nurse Case Manager/Utilization Review Nurse I (Job Requisition #19241), is open to all State employees and external applicants.
If you would like more information about this position, please contact heather.bollman@vermont.gov.
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.
Class Definition
Specialized nursing work at a professional level assessing, evaluating, documenting, and/or authorizing clinical service delivery. Areas may include: inpatient and outpatient services, Skilled Nursing Minimum Data Set (MDS), clinical procedures, durable medical equipment, high tech nursing services, in home care and/or holistic clinical case management, to support health and health outcomes and payment for services for individuals with a variety of complex health conditions. Setting is based upon agency of hire and may include office, facility, or field based work. Individual reports to nurse supervisor, manager and/or director and works closely with the Medical Director.
Environmental Factors
Duties are performed in a facility, 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. 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 AND three (3) 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 licensure as a Registered Nurse as a condition of employment.
Preferred Qualifications
Bachelor of Science in Nursing (BSN).
Case management experience/certification, knowledge and experience with working with systems of healthcare, prior work in an Insurance Company setting is ideal. Experience working with people with substance abuse/mental health and home visiting experience and knowledge of community is preferred. Case management certification within 2 years is a goal for this position. Loan repayment may be available via federal/state eligibility requirements.
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
- 80% State paid medical premium
- Dental Plan at no cost for employees and their families
- Flexible Spending healthcare and childcare reimbursement accounts
- Two ways to save for your retirement: A State defined benefit pension plan and a deferred compensation 457(b) plan
- Work/Life balance: 11 paid holidays each year and a generous leave plan; many jobs also allow for a flexible schedule
- Low cost group life insurance
- Tuition Reimbursement
- Incentive-based Wellness Program
- Qualified Employer for Public Service Student Loan Forgiveness Program
Equal Opportunity Employer
Nearest Major Market: Vermont