Current Career Opportunities

Responsibilities

• Perform the primary functions of case management–assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy–as appropriate in the health plan context to help members with high health complexity overcome biological, psychological, social and/or health system barriers to improvement and to achieve their desired clinical and functional outcomes.
• Conduct comprehensive assessments and develop personalized care plans in accordance with professional case management and accreditation standards, using evidence-based tools and applying relationship-building, motivational interviewing, risk-prioritization, and other related skills.
• Work collaboratively with members, families, and providers throughout the case management process, drawing upon knowledge of clinical, regulatory, and quality standards, health plan products and benefits, and community resources.
• Support members at all stages of their health care journey and across multiple settings and specialty areas, connecting with multiple providers and community-based organizations; guide members in accessing services to support their health and wellness goals in accordance with their benefits, partnering effectively with the Plan’s customer service, providers relations, and/or utilization management teams.
• Demonstrate a commitment to integrated, multi-disciplinary practice by proactively tapping into the expertise of the Plan’s clinical team of physicians, nurses, mental health clinicians, pharmacists, and colleagues in other departments who can help ensure the best possible experience and outcomes for the member.
• Participate in department and organization-wide initiatives to enhance member health and wellness, improve the quality of care, and generate cost-savings for our customers.

Qualifications

• Graduate of an approved program in professional nursing: RN, VT licensure and ability to apply for Compact License or active multi-state licensure required, BSN desired.
• OR Licensed Clinical Social Worker (LICSW) in the State of Vermont or comparable degree and licensure in an allied mental health profession.
• 5 years of varied clinical practice experience required, preferably in a health care setting. Experience in the following clinical areas strongly desired: inpatient and post-discharge care, management of chronic conditions, including medical and mental health conditions, and substance use disorders.
• 1-3 years of case management or similar experience desired. 
• Active CCM certification preferred or initiated within 2 years of hire. Completion of CCM certification required within 3 years of hire   

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Responsibilities

• Execute utilization management processes to ensure the delivery of medically necessary and appropriate, cost effective and high-quality care through the performance of clinical reviews.
• Review requests against standardized medical necessity and appropriateness criteria for an initial and a continued service authorization.
• Identify questionable cases and refer to superior or a medical director for review.

Qualifications

• RN with Vermont License required; BSN desired.  
• 5 – 7 years of clinical practice required.
• 1- 3 years of insurance related experience desired.  
• Must be willing to participate in on-going CEU training.

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Senior Network Engineer Responsibilities

• Work closely with contracted consultants and vendors, the Information Security team, and Systems Administrators and Engineers to design and implement computer networks which meet internal and external constituent needs.
• Integrate computer and network systems into the Blue Cross VT network, extended network (private/hybrid cloud) and worldwide Internet access.
• Provide complex, high-level technical support for computer and network systems, and carry out novel and/or complex assignments requiring the development of new and/or improved techniques and procedures.
• At times, this position may work with contracted consultants on installing, maintaining. repairing, modifying, and troubleshooting a variety of complex communication and electronics equipment (telephony, call centers). 

Senior Network Engineer Qualifications

• A bachelor’s degree in computer science field or equivalent is required. 5+ years of network experience including Cisco equipment.
• Telecommunications experience preferred.
• Certifications such as CCNP, CCNA preferred, with a strong focus on good information security practices.

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