- Humana (Montpelier, VT)
- …of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting ... holiday per calendar year** **Job Description:** The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting… more
- Humana (Montpelier, VT)
- …part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- Highmark Health (Montpelier, VT)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... Utilize robust, data-driven insights from complex healthcare datasets (eg, claims, clinical , utilization , pharmaceutical) to inform policy development, identify… more
- Humana (Montpelier, VT)
- …corporate communications to be shared with senior leadership. + Supports trend management by conducting analysis of drug spend, utilization , and/or approval ... communicating with staff in different positions and all levels of management positions + Manages the Humana Michigan FIDE-SNP health plan relationship with our… more
- Evolent (Montpelier, VT)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse… more
- Evolent (Montpelier, VT)
- … Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Highmark Health (Montpelier, VT)
- …per week (Tuesday-Thursday).** This role supports the full application product lifecycle for ** clinical and utilization management software** , with a ... and technical teams. They function as a pivotal bridge, translating high-level ** clinical and utilization management software** business needs into… more
- Evolent (Montpelier, VT)
- …Cardiologist)** Are you ready to make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a Field Medical ... appropriate, high-value care aligned with clinical guidelines. + Collaborate with leadership, management , and clinical staff to address complex cases and… more
- Parexel (Montpelier, VT)
- …Data Management Lead to join our team. If you have a passion for clinical research, strong project management skills, and a knack for data management , ... Science, OR equivalent industry experience. + 7+ years experience in pharmaceutical/biotech clinical data management / Biometrics ( clinical trial data… more
- Evolent (Montpelier, VT)
- …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Evolent (Montpelier, VT)
- …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Evolent (Montpelier, VT)
- …As a Field Medical Director, MSK Surgery you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... better health outcomes. Collaboration Opportunities: + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Evolent (Montpelier, VT)
- …Doing:** As a Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... better health outcomes. **Collaboration Opportunities:** . Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Oracle (Montpelier, VT)
- …user efficiencies, improved care coordination, reduced readmissions, increased access and utilization , and enhanced clinical workflows. * Training & Education: ... achieving health network goals. Key Responsibilities: * Client Consultation & Relationship Management : o Serve as the strategic lead for client engagements, working… more
- Highmark Health (Montpelier, VT)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... executing all facets of the Informatics project management process, leading multiple project managers, and potentially guiding, mentoring, or providing senior-level… more
- University Of Vermont (Burlington, VT)
- …90 faculty members (including 24 tenure-track and 66 non-tenure-track faculty) and 31 staff . CNHS faculty are teacher-scholars and clinical experts who bring ... academic community committed to excellence in teaching, research, and clinical practice. This is a pivotal time for CNHS...highly collaborative leader who will engage students, faculty, and staff in new ways. They will partner with colleagues… more
- Oracle (Montpelier, VT)
- …+ **Informatics and Strategy** : Work as intermediaries between IT professionals and clinical staff , ensuring that technological changes align with clinical ... providers, nurses, and pharmacists. This role requires a unique blend of clinical expertise, leadership, informatics, change management , and data science skills.… more
- Highmark Health (Montpelier, VT)
- …program and project management OR d) management of professional analytic staff in a business, clinical or technology function + 5-7 years of experience ... of various projects and data analysis related to Medical Policy and Utilization Management . **ESSENTIAL RESPONSIBILITIES** + Perform management … more
- Humana (Montpelier, VT)
- …care industry, Integrated Delivery Systems, health insurance, or clinical group practice management + Utilization management experience in a medical ... put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D...with prior experience participating in teams focusing on quality management , utilization management , or similar… more
- Evolent (Montpelier, VT)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management ...policies and procedures. + Documents communications with medical office staff and/or MD provider as required. + Interfaces with… more