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Title:  Nurse Case Manager - Utilization Review Nurse I

Application Deadline Date:  04/30/2020
Req ID:  3602
Department:  Vermont Health Access

St Johnsbury, VT, US

Position Type:  Permanent
Schedule Type:  Full Time
Hourly Rate:  $35.44

The Utilization Review Nurse will work as part of a local and state wide team on individual and population health goals within the Department of Vermont Health Access. This position has a Monday through Friday schedule and no on call hours. Professional nursing skills and associated case management supports required to assess, plan, implement and evaluate clinical service delivery, health coaching and service coordination for medically and socially complex individuals accounting for the vary risk level categories of Medicaid covered services.


The population served by the Vermont Chronic Care Initiative (VCCI) includes at risk and high risk Medicaid beneficiaries; as well as members new to Medicaid health plan for screening and facilitation to health and health related community services. The goals of VCCI case management services are to assure individuals have a medical home, are accessing appropriate health services, receive evidence based care and have the skills and confidence to more effectively self-manage their own health, which ultimately will reduce ambulatory sensitive hospitalizations and ED visits. Using a holistic approach and motivational interviewing skills, the nurse works with the beneficiary 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 plan of care that supports health improvement through appropriate service utilization (medical home, prescription access, transportation to medical appointments, etc). The nurse uses approved assessment/screening tools to identify service needs as well as gaps in care, establish a priority based plan of care in partnership with the primary care provider and patient and implements the plan of care based on evidence based standards, program goals/metrics and Medicaid rules, with input from the VCCI Manager and oversight by the Medicaid-Chief Medical Officer. Work will be performed in the field (home visits) and may be performed in the office and provider practices or other community settings depending on the area of clinical assignment.


This position covers Orleans, Essex & Caledonia Counties. Travel to off-site appointments and meetings should be anticipated for which a private means of transportation is required. Computer proficiency including Microsoft Office programs is a core requirement.

Who May Apply

This position, Nurse Case Manager/Utilization Review Nurse I (Job Requisition # 3602), is open to all State employees and external applicants.

If you would like more information about this position, please contact Heather Bollman at heather.bollman@vermont.gov.

Please note that multiple positions in the same work location may be filled from this job posting.

Resumes will not be accepted via e-mail. You must apply online to be considered.


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's degree in nursing preferred. Case management experience/certification, knowledge and experience with working with systems of healthcare, prior work in an Insurance Company setting are 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
As a State employee you are offered a great career opportunity, but it's more than a paycheck. The State's total compensation package features an outstanding set of employee benefits that are worth about 30% of your total compensation, including:
  • 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
Want the specifics? Explore the Benefits of State Employment on our website.
AHS Affirmative

The Vermont Agency of Human Services strives to build a diverse and inclusive community. It is our fundamental belief that in order to create and sustain a healthier Vermont, we as an organization must honor the cultures, beliefs and values of those we serve in order to foster an environment of mutual respect, acceptance and equal opportunity.  We are committed to building and maintaining a multicultural and diverse workforce which reflects the increasing diversity of Vermont. To view the State of Vermont's Equal Employment Opportunity/Affirmative Action Policy, please click here.

Equal Opportunity Employer
The State of Vermont is an Equal Opportunity Employer. Applications from women, individuals with disabilities, veterans, and people from diverse cultural backgrounds are encouraged.

Nearest Major Market: Vermont