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:

• Work alongside our clinical review team as part our Utilization Management department

• Verify member benefits, provider networks, and prior approval requirements for authorization of services in a call center environment

Qualifications: 

• Experience working in the medical field as an office assistant, medical coder, or Licensed Nursing Assistant is preferred

• Familiarity with medical terminology is helpful

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Responsibilities

• Complete a program comprised of classroom and on-the-job training that will provide the technical knowledge and customer service skills needed to accurately answer most member and provider questions.
• Learn and utilize customer service skills in order to successfully handle all customer interactions in a consistent, courteous, and professional manner.
• Accurately document, track, and research all inquiries in Customer Focus (CF) according to department guidelines and written procedures.
• Achieve a level of call volume and quality goals as set forth in the Customer Service Career Pathing Guidelines. Successful achievement of these goals will help enable to CSR to transition to a Customer Service Representative II position.

Qualifications

• High school graduate or equivalent required.
• Analytical and critical thinking skills required.
• Computer literacy, strong typing and spelling skills required.
• One to two years of successful customer service experience, preferably in a health insurance or health care setting is desired.
• The ability to multitask, problem solve and work independently is necessary.

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Responsibilities

• Facilitate the prompt and effective resolution of technical and production issues for all workforce members of Blue Cross VT.
• Use judgment, analysis, and initiative to resolve problems, make recommendations based on corporate standards, and deliver impromptu end-user operational assistance as needed.
• Maintain communications with requestors throughout the analysis and resolution process particularly in higher severity incidents, keeping them informed of status and escalating issues if deemed necessary.
• Identify systemic issues (e.g., system outages, widespread processing errors) and take ownership of the end-to-end process to optimize the customer experience.

Qualifications

• Minimum Associates Degree in computer science or a related field; Bachelor's degree preferred.
• In-depth knowledge of computer systems and mobile devices.
• Hands on experience with diagnosing and resolving basic technical issues.
• Excellent communication and interpersonal skills, customer-oriented and patient.

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Responsibilities

• Provide data, reporting, and analytical expertise to strategic teams focused on provider reimbursement and value-based care initiatives.
• Calculate, monitor, and track performance, use data to support informed business decisions, and participate in the decision-making process. 
• Prepare financial and utilization models to illustrate the impact of changes to provider reimbursement, contract provisions, medical policies and practices, benefit plans, products, and quality improvement activities.
• Prepare and maintain documentation related to standard operating procedures as well as routine and special projects.
• Participate in meetings with external parties (employer groups, providers, regulators, etc.), develop presentations, and convey information to advance the Plan’s strategic objectives and fulfill the Plan’s obligations.
• Mentor junior staff as required

Qualifications

• Bachelor’s degree in health care, business, statistics, math or a closely related field required, advanced study desirable.
• 5-7 years of closely related experience with one to three (1-3) years of demonstrated independent work required. 
• 3-5 years of managed care and health insurance experience, including experience in reimbursement methodologies, data research and reporting preferred. 
• Knowledge of commercial and Medicare payment methodologies strongly preferred. 
• Advanced Microsoft Excel required, and SAS programming knowledge strongly preferred.

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