Current Career Opportunities
Current Openings
Responsibilities
- Oversee day-to-day administration of the organization’s privacy operations including oversight of permitted access, use, and disclosure of information.
- Serve as incident Response Coordinator and lead privacy incident investigations and perform risk assessments, including coordination with IT, Compliance, and executive stakeholders.
- Develop and enhance privacy policies, procedures, and training programs.
- Interpret state and federal statutes and regulations that impact the Corporation, including those pertaining to federal and state legal and regulatory requirements applicable to the Corporation.
- Support regulatory audits, filings, and examinations while proactively assisting Compliance and operational teams in addressing regulatory risk.
- Draft, review, and negotiate vendor agreements, non-disclosure agreements (NDAs), business associate agreements (BAAs), and related commercial contracts.
Qualifications
- Graduate of an ABA accredited law school, holds JD degree.
- Admitted to practice before the Vermont Bar.
- 3-5 years in a law firm or corporate law department, healthcare, privacy, insurance, or regulatory exposure preferred.
- Working knowledge of HIPAA and healthcare regulatory frameworks.
- Experience drafting and negotiating commercial contracts.
- Strong analytical judgment and ability to translate complex legal uses into practical business guidance.
- Demonstrated initiative, ownership mentality, and ability to perform in a fast-paced, evolving environment.
- Comfort engaging directly with senior stakeholders and managing high visibility matters.
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 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.
Responsibilities
- Serve as the physician leader for medical management, with primary accountability for utilization management (UM) decision making, including physician-level medical necessity determinations, prior authorization reviews, appeals, and provider-to provider discussions.
- Oversee the work of the Director, UM and works closely with the UM team and other Medical Directors to ensure reviews are completed within required state and NCQA timeframes.
- Serve as the final clinical authority for medical necessity determinations in accordance with medical policy and regulatory requirements.
- Contribute to the continuous improvement of UM operations to enhance efficiency, consistency, and effectiveness, and partners with the Quality, Case Management, Provider Relations, and Payment Integrity teams to support coordinated care, improved member outcomes, and using lower cost, effective alternatives for responsible healthcare cost management.
- Play a key role in developing, training, and supporting UM staff, and actively uses UM technology platforms and clinical criteria systems to support high-quality, timely decision making.
Qualifications
- Unrestricted Vermont medical license compliant with leadership and infrastructure requirements of Vermont State Law, URAC, and NCQA.
- M.D. or D.O. degree.
- Board certification in an American Board of Medical Specialties (ABMS) approved specialty.
- 7-10 years of clinical practice experience combined with 3 years of clinical management experience serving as a physician reviewer for UM, prior authorization, and appeals in a health plan or managed care environment.
- Prior medical administrative background is highly desirable.
- Advanced management degree or equivalent preferred.
- Excellent knowledge of local health care delivery systems and existing relationships with local network providers and medical facilities is highly desirable.
- Must be able to work a hybrid schedule working a minimum of one to 1-2 days onsite; with Vermont residency preferred.
Responsibilities
- Manage the end-to-end retrieval process of medical records
- Responsible for requesting, collecting, organizing, and analyzing medical records from providers and other external sources for initiatives related to risk adjustment, documentation, and coding accuracy.
- Maintain and expand our ability to access medical data in Electronic Health Record (EHR) systems while ensuring compliance with HIPAA and privacy regulations.
- Work as a conduit between vendor organizations, copy service vendors, internal departments, and the risk adjustment team.
- Work closely with the network management, provider relations, and actuary departments to ensure program efficiency and streamlined provider communication, collaboration, and education relating to the successful retrieval of medical records.
- Occasional travel throughout the state of Vermont will be required. Valid driver’s license and owning a vehicle is required for travel.
Qualifications
- High school diploma required.
- Two years’ experience as a Certified Medical Assistant, Certified Nursing Assistant (CNA) or Licensed Nurses Assistant (LNA), preferred.
- This position requires occasional travel throughout the state of Vermont. Valid driver’s license and owning a vehicle is required for travel.
Responsibilities
- Responsible for the overall Microsoft 365 and related systems infrastructure including engineering, implementation and integration, and technical services and support.
- Design, implement, install, maintain, and administer infrastructures built on Microsoft technologies including hardware, software, and various configurations.
- Monitor overall performance to proactively identify potential issues and tune appropriately.
- Perform root cause analysis on failed components and implement corrective measures.
- Work with others to establish and improve processes and procedures.
- May have sole responsibility for projects and participate in disaster recovery exercises.
Qualifications
- Bachelor’s degree in computer science or equivalent field, or equivalent experience.
- Minimum 4-6 years professional experience in information systems and/or Microsoft 365 systems administration.
- Proven ability to work with infrastructure production support teams and management of external service providers.
- Experience within the US healthcare industry is desired.
- Experience with Information Security solutions is desired.
Responsibilities:
- Responsible for the overall systems infrastructure including engineering, implementation and integration, and technical services and support.
- Design, implement, install, maintain, and administer infrastructures including hardware, software, and various configurations.
- Monitor overall performance to proactively identify potential issues and tune appropriately
- Perform root cause analysis on failed components and implement corrective measures
- Work with others to establish and improve processes and procedures
- May have sole responsibility for projects and participate in disaster recovery exercises.
Qualifications:
- Bachelor’s degree in computer science or equivalent field, or equivalent experience.
- At least seven (7) years professional experience in information systems and/or network administration with significant network or systems engineering and architectural experience.
- Proven ability to work with infrastructure production support teams and management of external service providers.
- Professionally delivered, information architecture or systems engineering training resulting in industry certification at the network engineer or architect level (e.g., MS Certified Professional).
- Experience within the US healthcare industry is desired.
- Experience with Information Security solutions is desired.
Blue Cross and Blue Shield of Vermont strictly prohibits discrimination against or by any Blue Cross and Blue Shield employee on the basis of race, color, religion, gender, age, national origin, place of birth, sexual orientation, gender identity, ancestry, disability, pregnancy, genetic information or marital status. Blue Cross and Blue Shield will not discriminate against an employee having a positive test result from an HIV related blood test, nor will Blue Cross and Blue Shield request or require an applicant or employee to have an HIV-related test as a condition of employment. Blue Cross and Blue Shield of Vermont will not discriminate against protected veterans.