---

---

Location

Middletown, CT | United States

---

Job description

Are you a Registered Professional Nurse (RN) seeking an opportunity to make a significant impact?

Join our dynamic team and play a pivotal role in making lasting, positive changes throughout communities across Connecticut!

The State of Connecticut, Department of Mental Health and Addiction Services (DMHAS) is seeking an experienced and qualified individual for the role of Utilization Review Nurse Coordinator.

POSITION HIGHLIGHTS

• FACILITY: Connecticut Valley Hospital (CVH)
• DIVISION: Addiction Services Division (ASD)
• TEAM: ASD Utilization Management Unit
• ADDRESS: 1000 Silver Street, Middletown, CT 06457
• SCHEDULE: Full time, first shift | Monday - Friday 8:00am-4:30pm
• POSITION NUMBER: 25176

WHAT WE CAN OFFER YOU

• The opportunity to work for a Forbes top company: 'Forbes' State of Connecticut Ranked One of the Best Employers of 2023 - State of CT Receives National Recognition for Offering Job Growth, Competitive Benefits, and Flexible Schedule.
• NEW: A Platinum Healthcare Plan, the nation’s best for state employees and dependents, according to a report by Georgetown’s Center on Health Insurance Reform and article by Ellen Andrews, Ph.D., along with comprehensive benefit offerings.
• Extensive pension plan and supplemental retirement offerings.
• State of Connecticut is an eligible Public Service Loan Forgiveness employer, meaning you may be eligible to have qualifying student loans forgiven after 10 years of service. Click here for more information.
• Generous paid time off, including 13 paid holidays per calendar year.
• Professional growth and development opportunities.
• A healthy work/life balance to all employees.

DISCOVER THE OPPORTUNITY TO

• Be a part of a comprehensive team of caring professionals;
• Provide support to hospital that is passionate about improving the lives of those we serve;
• Assist our clients and employees so they can achieve success;
• Make a difference in the public sector; and
• Work together in a collaborative team environment.

OUR MISSION

DMHAS is a health care agency whose mission is to promote the overall health and wellness of persons with behavioral health needs through an integrated network of holistic, comprehensive, effective, and efficient services and supports that foster dignity, respect, and self-sufficiency in those we serve.

Selection Plan

FOR ASSISTANCE IN APPLYING:

Please read or watch our Applicant Tips on How to Apply!

Please Note:

In order to receive educational credits toward qualification for this job posting, the institution must be accredited. If the institution of higher learning is located outside of the U.S., you are responsible for providing documentation from a recognized USA accrediting service which specializes in determining foreign education equivalencies to the recruiter listed on this job posting.

Please Note:

For current state employees, salary calculations are not necessarily comparable from one of the three branches of state government (i.e., Executive, Legislative, Judicial) to the other.

To Apply:

• In order to be considered for this job opening, you must meet the Minimum Qualifications as listed on the job opening. The minimum experience and training requirements must be met by the close date on the job opening, unless otherwise specified.
• You must specify your qualifications on your application. You will be unable to make revisions once you submit your application for this posting to the JobAps system.
• In order to comply with Public Act 21-69, the State of Connecticut is no longer asking for resumes during the initial application process.
• All application materials must be received by the recruiting agency by the time specified on the job opening for the position for which you are applying. Late applications may not be submitted and will not be considered. Exceptions are rare and limited to documented events that incapacitate a candidate during the entire duration of the job posting time period. It is the candidate’s obligation and responsibility to request an exception and provide a legally recognized justification to accommodate such exception. Requests should be made to [email protected].
• This position will be filled in accordance with contractual language, reemployment, SEBAC, transfer, promotion and merit employment rules.

Important Next Step Information for After You Apply:

• Although applicants will receive correspondence via email, as a backup they are also encouraged to sign on to their Personal Status Board on a daily basis to monitor their status, view all emailed notices and complete tasks required in the recruitment process.
• This posting may require completion of additional referral questions (RQs). You can access these RQs via an email that will be sent to you after the posting's closing date or by visiting your JobAps Personal Status Board (Certification Questionnaires section). Your responses to these RQs must be submitted by the question's expiration date. Please regularly check your email and JobAps Personal Status Board for notifications. Please check your SPAM and/or Junk folders on a daily basis in the event an email provider places auto-notification emails in a user's spam.
• Note: At any point during the recruitment process, applicants may be required to submit additional documentation which support their qualification(s) for this position. These documents may include: a cover letter, resume, transcripts, diplomas, performance reviews, attendance records, supervisory references, licensure, etc., at the discretion of the hiring agency.
• The immediate vacancy is listed above, however, applications to this recruitment may be used for future vacancies in this job class.
• Interviews will be limited to candidates whose experience and training most closely meet the requirements of the position.
• Candidates who are offered and accept a position with the State of Connecticut are bound by the State Code of Ethics for Public Officials and State Employees which is available at

Connect With Us:

• Due to the large volume of applications received, we are unable to provide confirmation of receipt or status during the recruitment process.
• Updates will be available through your JobAps portal account. If you have any questions pertaining to this recruitment please contact Pamela Rochette via email at [email protected].

PURPOSE OF JOB CLASS (NATURE OF WORK)

In a state agency this class is accountable for coordinating a utilization review program which promotes effective cost recovery, quality of care and/or compliance with relevant federal and state laws, regulations and standards.

In the Department of Developmental Services this class is accountable for performing investigations of abuse, neglect and death in individuals with an intellectual disability including individuals under the care of the Department of Developmental Services.

EXAMPLES OF DUTIES

WORKING LEAD (REGULATORY):

• Coordinates workflow and determines priorities to assure highest quality of care with efficient utilization of available services;
• Schedules, assigns, oversees and reviews work;
• Establishes and maintains program protocols and procedures;
• Provides staff training and assistance;
• Conducts or assists in conducting performance evaluations;
• Acts as liaison with other operating units, agencies and outside officials regarding program policies and procedures;
• Prepares reports and correspondence;
• Assesses, evaluates and monitors documentation of all hospital disciplines when performing case reviews;
• Attends professional workshops, seminars and in-service training;
• May supervise Utilization Review Nurses and other staff engaged in review of medical records of individuals in state health care facilities for purposes of maximizing reimbursement revenue via Medicare Part B programs;
• May review medical records and compile documents for case presentations;
• May provide pre-certification for and coordination of inmates admitted to and discharged from acute care facilities;
• May lead an inspection team in IPR/UR and licensing review functions;
• May conduct entrance and exit interviews of care providers;
• May supervise and participate in hospital Medicare and Medicaid reimbursement programs including preparation of appeals on behalf of a facility relative to intermediate denials;
• May testify in court;
• May coordinate review and audit of occupational injury and/or disease disability cases for purpose of determining medical management, cost containment, peer review and rehabilitation;
• May notify acute care hospitals of scheduled utilization review including conducting second level review of cases and case referral to a physician consultant for final disposition;
• Performs related duties as required.

KNOWLEDGE, SKILL AND ABILITY

• Considerable knowledge of
  • principles, practices and current trends of nursing;
  • standards of medical care
• Considerable
  • interpersonal skills;
  • oral and written communication skills;
• Considerable ability to analyze individual profiles and progress charts;
• Supervisory ability.

REGULATORY:

• Considerable knowledge of
  • and ability to apply relevant state and federal laws, statutes and regulations;
  • regulations and standards pertaining to utilization review;
  • care and service delivery to injured workers.

INVESTIGATORY:

• Considerable knowledge of
  • statutes, policies and procedures governing the care and treatment of individuals with an intellectual disability;
  • problems and needs of individuals with an intellectual disability;
  • various types of residential placement facilities;
• Knowledge of investigatory methods and techniques;
• Considerable
  • interviewing skills;
  • skills in the preparation of extensive written reports;
• Ability to research and analyze data.

DEPARTMENT OF VETERANS AFFAIRS:

• Knowledge of Minimum Data Set process in a long-term care setting and coordination of an interdisciplinary team;
• Ability to utilize computer software.

MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE

Five (5) years of experience as a registered professional nurse.

MINIMUM QUALIFICATIONS - SPECIAL EXPERIENCE

REGULATORY: Two (2) years of the General Experience must have been in the assessment of the quality and propriety of health care services as required by Joint Commission on Accreditation of Healthcare Organizations (JCAH) and/or Medicare and Medicaid standards and regulations at the level of Utilization Review Nurse.

INVESTIGATORY: Two (2) years of the General Experience must have been working with persons with behavioral health disabilities or an intellectual disability.

DEPARTMENT OF VETERANS AFFAIRS: Two (2) years of the General Experience must have been in the review and assessment of individuals in a long-term care setting.

MINIMUM QUALIFICATIONS - SUBSTITUTIONS ALLOWED

A Bachelor's degree in nursing may be substituted for one (1) year of the General Experience.

PREFERRED QUALIFICATIONS

• Experience applying managed care principles to the provision of care.
• Experience with Medicare & Medicaid Regulatory Requirements and private insurance as it relates to utilization review/management and quality of care.
• Experience using and establishing medical necessity criteria to obtain Initial and Continued Stay Authorizations.
• Experience with peer to peer medical/clinical reviews.
• Experience with the Managed Care Appeal process.

SPECIAL REQUIREMENTS

• Incumbents in this class must possess and retain a current license as a registered professional nurse in Connecticut.
• Incumbents in this class may be required to travel.

---

Job tags

---

---

Salary