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: 

1. Perform the primary functions of outreach and enrollment for Integrated Health programs, such as: 
   1. Create care enrollments in our documentation system
   2. Manage multiple ingests and queues of referrals and requests for programs
   3. Triage cases to evaluate member needs including case research utilizing multiple systems, and following case management guidelines
   4. Engage in cold-call member outreach
   5. Screen members for medical and behavioral health needs
   6. Support brief member requests and care coordination
   7. Complete and enter health assessments
   8. Document clearly and concisely in screening tool and notes
   9. Use critical thinking to determine member support needs
   10. Identify proper distribution of cases throughout the department and company, as needs arise  
2. Demonstrate a commitment to integrated, multi-disciplinary practice by working collaboratively with colleagues (internal and external), members, families, and providers throughout the case management process. Practice ongoing supportive research, coordination activities, follow-up calls and administration of screenings and surveys as needed throughout the entirety of an open case to streamline support and care for the member.
3. 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.
4. Identify and refer members for all IH programs based on appropriate referral triggers, including auto triggers, high dollar lists, and predictive modeling reports.
5. Identify and maintain an internal reference tool of up-to-date community resources and services that the IH team can use to best serve members.    
6. Demonstrate a high level of professional and service excellence in all interactions, internal and external, focusing on the development of strong, collaborative relationships.  
7. Demonstrate an in-depth working knowledge and understanding of departmental policies, procedures, and workflows; identify possible improvements and/or revisions.
8. Adhere to program, departmental, and organizational performance metrics and targets that drive productivity, service, clinical, quality, regulatory, and financial objectives.
9. Demonstrate continued learning and professional development by attending in-service and other training that addresses the relevant population served, and any mandatory training.

QUALIFICATIONS: 

• Associate’s degree or equivalent experience in a related health care field preferred. 
• 3-5 years’ experience in a health care setting required, including experience in a similar member- or patient-facing outreach and coordination role. 
• Proficient in Excel and MS Word
• Prior experience in a member-facing role in a health plan preferred. 
• Certification or licensure in a clinical field a plus.

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Responsibilities:

• Prepare monthly journal entries to record subscription income, claims, administrative expenses, and other financial activity for the Plan and its subsidiaries.
• Prepare general ledger and bank account reconciliations to ensure the accuracy and integrity of financial reporting.  Performs monthly close of general ledger, purchasing, accounts receivable and accounts payable accounting modules.   
• Generate and prepare monthly invoices to clear cash activity between the Plan and its subsidiaries.
• Provides professional accounting services to the following Treasury tasks:
  • Level Pay program: reconciliation of balances, preparation and execution of transactions, and control of subsidiary ledgers.
  • Daily cash flow analysis including daily monitoring of bank records, cash transactions and Plan records.
  • Inter-Plan Program accounting.
  • Federal Employee Program accounting
  • Assist with annual and ad hoc audit requests

Qualifications:

• BS degree in Accounting or Finance 
• 1-3 years of professional accounting experience required
• Strong knowledge in general accounting theory and practice
• Strong knowledge in journal entry and reconciliation  

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