- CenterWell (Montpelier, VT)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Montpelier, VT)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Dartmouth Health (Bennington, VT)
- …Three-Five years of clinical nursing experience required. Prior experience in utilization review, discharge planning and/or case management preferred. VT ... The Health Resource Manager is responsible for providing case management services for SVMC sub acute patients.The case manager...Nursing License required by date of employment. Case Management Certification required within 2 years of employment. *… more
- Evolent (Montpelier, VT)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- BAYADA Home Health Care (St. Albans, VT)
- …and the ability to create alignment to common goals across multiple levels of management ? Would you like to be viewed as a trusted advisor and senior living ... out by all team members to deliver on our differentiated offerings. Through the utilization of outcome driven data analytics, this role will analyze key metrics and… more
- Dartmouth Health (Bennington, VT)
- …matriculated into a BSN program may be considered.Prior experience in utilization review, discharge planning and/or case management preferred.3-5years of ... clinical nursing experience and BS required. BSN preferred. Prior experience in utilization review, discharge planning and/or case management preferred. VT… more
- Intermountain Health (Montpelier, VT)
- …+ Care Management Certification + Demonstrated experience in case management , utilization review, or discharge planning. + Bi-Lingual/Spanish Speaking ... The RN Ambulatory Care Manager I delivers comprehensive ambulatory care management services to identified patients. Leveraging clinical expertise, this role involves… more
- Sharecare (Montpelier, VT)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- GE Aerospace (Rutland, VT)
- …within manufacturing lines to achieve Operating goals using **KPI-based** performance management . + **Coach and Collaborate** with all levels of the organization ... of Lean principles. + Partner, develop and execute standard **Capacity Utilization ** process in partnership with the local Operations, Lean and Industrial… more
- Highmark Health (Montpelier, VT)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more