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
• Reviews requests against standardized medical necessity and appropriateness criteria for an initial and continued service authorization
• Identify questionable cases and refers 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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Responsibilities

• As a storyteller and skilled writer, balance “big picture” thinking with relevant, targeted messaging to reach and motivate target audiences.
• Plan, write, and edit long- and short-form content within required deadlines, carrying the brand voice through a variety of internal and external communications channels, both digital and print.
• Excel as a strong listener, interviewer, and investigator who translates complex business and healthcare information into meaningful and effective content.
• Work closely with organizational leaders and internal partners to develop, implement, and evaluate communications and project plans that support organizational priorities and goals.
• Ensure organizational priorities, initiatives, and updates are clearly communicated across internal channels in a relevant, timely, and targeted manner.
• Establish evaluative criteria for monitoring the effectiveness of communications activities to help ensure desired results and the appropriate tracking methods.
• Plan and coordinate special projects, events, or other tasks as needed.

Qualifications

• Bachelor’s degree, preferably in communications, journalism, or public relations, or equivalent work experience.
• Minimum of 6+ years of professional writing or journalism experience, preferably with a communications or marketing team or agency. Healthcare industry experience a plus.
• Demonstrated experience writing for a variety of audiences.  
• Prior management of complex projects and advising leadership.
• Proven ability to work with clients across all levels of the organization.
• Solid problem-solving and time-management abilities.
• Outstanding verbal and written communication skills.
• Excellent interpersonal and teamwork skills. 

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If you’re looking to start a career in an ever-changing health insurance industry with best-in-class benefits, competitive pay and many opportunities for advancement, we want to speak with you about our Customer Service openings. Strong candidates will learn quickly, apply solid computer and communication skills, and exhibit exceptional attention to detail. 

• Starting pay at $20.00 per hour with multiple promotional opportunities within the first two years.
• Our eight-week in-person training program is located at our Berlin, Vermont office. Representatives will continue working on-site five days per week for two to three months post-training, or until they’ve demonstrated proficiency in the role. After this time, employees within a 50-mile radius will be expected to come to the office on Wednesdays with flexibility to work remotely the rest of the week.
• Bi-annual department retention bonus program, annual corporate incentive program, and additional compensation opportunities throughout the year.

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Responsibilities

• Provide outstanding customer service with first call resolution and must maintain excellent relationships with our non-group, group customers as well as brokers and vendors.
• Maintain a high level of quality by entering new individual membership enrollment and all subsequent group and membership changes to the system file.
• Maintain regular contact with other departments across divisional as well as external vendors.

Qualifications

• High school graduate or equivalent with 1-3 years of either office bookkeeping experience, balance sheet account reconciliation, or insurance experience is desired.
• Prior Customer service experience preferred.
• Computer literacy and strong typing skills a necessity.
• Proven ability to multitask, problem solve, and work independently.
• Excellent communication and interpersonal skills, customer-oriented, and patience.

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Responsibilities

• Oversee maintenance of medical coding changes in our Payment Integrity programs
• Research requests using multiple systems (including: Sales Force, Jira, NPS) to provide all available details to reviewer
• Use SalesForce, Jira, and NASCO claim systems, to perform functions such as initial claim review, outcome reporting, and distribution based on triage
• Correspond with providers regarding decisions about requested services and obtain medical records when necessary
• Review and respond to issues and questions from internal and external customers, both verbally and in writing
• Work collaboratively with other departments to obtain additional information to resolve inquiries

Qualifications

• Bachelor’s degree, or equivalent combination of education and experience, with a minimum of 3 years’ experience in medical coding; In-depth knowledge of CPT, ICD-9, ICD-10, HCPCS, DRG diagnosis and procedure coding
• Formal coding certification (eg: CPC, AAPC) is a must
• Experience with both professional and facility claims coding and in APC, HIPPS, or RUG coding and validation

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