Current Career Opportunities
Current Openings
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 vendor contract management within the scope of the pharmacy department. Direct contracting experience is a must.
- Assists the Director and clinical pharmacists with day-to-day department operations.
- Assists with generating and maintaining reports, NCQA delegation oversight, data analytics, project implementation, audit support, client support, Request for Proposal (RFP) and Request for Rate (RFR) development, and business process improvement.
- Collaborate with the legal department to monitor legislative bills that may affect the pharmacy department and programs and assist with providing relevant pharmacy data, when required.
- Track pharmacy program performance with the assistance of pharmacist lead for the program. Help validate Return on Investments (ROIs) and financial viability of new and existing programs within the pharmacy department or through vendor partners by performing impact analysis for formulary changes, biosimilar switches, programs implementation (pre and post implementation), and rebate performance.
Qualifications
- Bachelor’s degree in healthcare administration, health science, public health or related field required.
- 7 or more years’ experience with vendor implementation, contracting, program implementation, or project management, preferably within a health plan or PBM or as a health plan consultant.
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
- Collects and discards litter or other waste materials.
- Operates a variety of maintenance equipment such as shovels, rakes, etc. to complete assignments.
- Operates power equipment and other vehicles such as tractors, mowers, electric clippers, and other similar machines.
- Ensures proper hydration of lawns, trees, and plants using hoses, watering cans, or other.
- Trims trees and vegetation and maintains flower beds.
- Maintains sidewalks, driveways, parking lots, planters, or other features; performs general cleaning.
- Delivers and spreads topsoil and/or straw over newly seeded areas.
- Installs and maintains specialty features such as gardens and flower beds.
- Performs other related duties as assigned.
Qualifications
- On-the-job training is offered.
- High school diploma/ GED
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.