University of Vermont Health Network

Compensation

Full Description

Building Name: UVMMC - In State Remote Worker Location Address: 111 Colchester Ave., Burlington Vermont Regular Department: Utilization Management Full Time Standard Hours: 36 Biweekly Scheduled Hours: 72 Shift: Day/Eve Primary Shift: 8:00 AM - 4:30 PM Weekend Needs: As Scheduled Salary Range: Min $40.64 Mid $53.01 Max $65.37 Recruiter: Kate Davies Please note: This is a remote position that requires evening and weekend scheduling. JOB SUMMARY: The incumbent provides the clinical expertise and professionalism for implementing the Medical Center’s Utilization Management Program. The Utilization Management (UM) Specialist has well-developed knowledge and skills in areas of utilization management (UM), medical necessity, patient status determination, appeals and denials. This individual supports the UM program by developing and/or maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers. Utilization review on all assigned patients using technology and best practice standards. At the direction of the Utilization Management leadership, the incumbent is responsible for the overall completion and reporting of outcomes of medical record audits and will also work to defend and overturn clinical denials from private insurance carriers, Medicare and Medicaid, as directed. They are an essential link between the patient, the healthcare team, the payer, and the community. EDUCATION: State of Vermont Registered Nurse (RN) license required. Case management accreditation required by a nationally recognized accrediting body for case management (examples: CCM, ACM or ANCC certifications), preferred. EXPERIENCE: Minimum of 3-5 years’ experience in a healthcare or clinical reviewer setting (or equivalent). WHY UVM MEDICAL CENTER (UVMMC)? UVMMC is dedicated to our patients, providing the highest quality care for patients and their families. It is a mission that defines our culture, one of teamwork and collaboration. Every employee, whether they work directly in patient care or in a supporting role, has a hand in contributing to the wellness of the patient and the community. BENEFITS: At UVMMC, we support our employees as passionately as we care for our patients. We offer a comprehensive, total compensation package that includes salary, health and wellness benefits, paid time off, and more. https://www.uvmhealth.org/medcenter/health-careers/benefits LEARN MORE: What is it like working here? https://www.uvmhealthnetworkcareers.org/diversity-equity-inclusion.html Find more information about the University of Vermont Health Network here: https://www.uvmhealth.org/about-uvm-health-network This is a bargaining union position. About Us The University of Vermont Medical Center is committed to being a national model for the delivery of high quality academic health care for a rural region. The University of Vermont Medical Center will continue to ensure that individuals are employed, and that employees are treated during candidacy and employment, without regard to their sex, gender identity or expression, ancestry, place of birth, HIV status, marital status, age, language, socioeconomic status, sexual orientation, race, color, religious creed, national origin, physical or mental disability, protected veteran status or obligation for service in the armed forces, or any other characteristic protected by law in all employment practices as follows: Employment decisions at The University of Vermont Medical Center are based on legitimate job related criteria. All personnel actions or programs that affect qualified individuals, such as employment, upgrading, demotion, transfer, recruitment, advertising, termination, rate of pay or other forms of compensation, and selection for training, are made without discrimination based upon the individual’s sex, gender identity or expression, ancestry, place of birth, HIV status, marital status, age, language, socioeconomic status, sexual orientation, race, color, religious creed, national origin, physical or mental disability, protected veteran status or obligation for service in the armed forces, or any other characteristic protected by law. UVMHealth.org/MedCenter The UVM Medical Center Blog EEO is the law.