Utilization Review Clinician

Make a difference and work with a diverse team of professionals as a Utilization Review Clinician at the Department of Vermont Health Access (DVHA)! DVHA's Clinical Integrity Unit (CIU) is seeking a Utilization Review Clinician who will be responsible for ensuring that Vermont Medicaid members are receiving clinical services that are medically necessary and at the appropriate level of care.

Have the work/life balance you need with a Monday-Friday schedule and a supportive hybrid work environment requiring minimal travel. Eleven paid state holidays, in addition to a robust benefits package.

The Utilization Review Clinician position works within the DVHA Clinical Services Team (CST), which is a team of mental health clinicians, nurses, pharmacists, dentists, physicians, and administrative assistants. This position does not involve direct service or require travel.

The Utilization Review Clinician has the following responsibilities:
* Work to ensure that Vermont Medicaid members are receiving clinical services that are medically necessary and at the appropriate level of care.
* Performing utilization review for inpatient psychiatric hospitalization and other mental health services. Utilization review is done in accordance with accepted department criteria and Medicaid Rule.
* Collaborate with providers, facilities and various departments within the Agency of Human Services to guarantee that members are receiving services that are both appropriate and of high quality.
* Provides opportunities to participate in additional projects and clinical initiatives in which the Clinician can utilize their clinical skills and knowledge more broadly.

Mission:
The Department of Vermont Health Access (DVHA)'s mission is to improve Vermonters' health and well-being by providing access to high-quality, cost-effective health care. We have identified three priorities that support our mission: Advancing value-based payments, modernizing information technology infrastructure, and operational performance improvement. Our department commits to executing our responsibilities and priorities while adhering to three core values: Transparency, Integrity and Service.

Diversity, Equity, and Inclusion:
As part of our values of transparency, integrity, and service, we are committed to supporting diversity, equity, inclusion, and accessibility as part of our person-centered culture. We actively celebrate our colleagues' and future colleagues' different abilities, racial identity, sexual orientation, ethnicity, age, and gender. Everyone is welcome and supported here.

Our State:
Vermont is a "small but mighty" state. We are ranked as one of the top 10 states to raise a family in 2022. We are nationwide leaders for progressive social and educational policies. We are in Northern New England, 1.5 hours from Montreal and 3.5 hours from Boston. We have beautiful Lake Champlain, the Green Mountains, and year-round outdoor activities.

Telework:
The Department of Vermont Health Access (DVHA) supports a hybrid work environment. Upon hire, employees work with their supervisor to create a schedule that aligns with the business needs of the unit. We believe a hybrid work environment promotes autonomy and allows for increased flexibility and greater work/life balance.

This position, Utilization Review Clinician (Job Requisition #52539), is open to all State employees and external applicants.
If you would like more information about this position, please contactdanielle.bragg@vermont.gov.
Resumes will not be accepted via e-mail. You must apply online to be considered.
Please note that multiple positions in the same work location may be filled from this job posting.

AHS BACKGROUND CHECKS: Candidates must pass any level of background investigation applicable to the position. In accordance with AHS Policy 4.02, Hiring Standards, Vermont and/or national criminal record checks, as well as DMV and adult and child abuse registry checks, as appropriate to the position under recruitment, will be conducted on candidates, with the exception of those who are current classified state employees seeking transfer, promotion or demotion into an AHS classified position or are persons exercising re-employment (RIF) rights.

Duties are performed largely in a standard office setting, but private means of transportation should be available for required travel outside of the office. Challenges occur on a regular basis involving obtaining appropriate services for discharge. Duties involve need for effective working relationships with a number of health care professionals.

Education: Master's degree in a mental health related field.

Experience: Four years of clinical experience in counseling, social work, psychology or nursing, including experience with adults, children and adolescents with severe emotional disturbance, including knowledge of treatment options (including inpatient treatment) for adults, children and adolescents.

*Master's degree in a mental health related field and four years or more of clinical experience in counseling, social work, psychology, or psychiatric nursing.
*Experience with adults, children, and adolescents with severe emotional disturbance and knowledge of treatment options.
*Currently licensed mental health professional such as Licensed Clinical Social Worker, Licensed Psychologist or Licensed Clinical Mental Health Counselor, or possession of a Vermont license within six months of hire.
*Strong clinical, communication, and writing skills.
*Ability to work with a diverse team of professionals.

Currently licensed mental health professional such as Licensed Clinical Social Worker, Licensed Psychologist or Licensed Clinical Mental Health Counselor, or possession of a Vermont license within six months of hire.

Reliable means of transportation required for off-site visits

As a State employee you are offered a great career opportunity, but it's more than a paycheck. The State's total compensation package features an outstanding set of employee benefits that are worth about 30% of your total compensation, including:

• 80% State paid medical premium and a dental plan at no cost for employees and their families
• Work/Life balance: 11 paid holidays each year and a generous leave plan
• State Paid Family and Medical Leave Insurance (FMLI)
• Two ways to save for your retirement: A State defined benefit pension plan and a deferred compensation 457(b) plan
• Tuition Reimbursement
• Flexible spending healthcare and childcare reimbursement accounts
• Low cost group life insurance
• Incentive-based Wellness Program
• Qualified Employer for Public Service Student Loan Forgiveness Program

Want the specifics? Explore the Benefits of State Employment on our website.