Utilization Review Nurse

1 month ago

Middletown, United States State of Connecticut Full time

Introduction
The Stateof Connecticut, Department of Children and Families (DCF), seeks qualifiedindividuals for a Utilization Review Nurse position.

Are you passionate about making a difference in the lives of children and adolescents? Do you have a proven track record in providing quality assurance and ensuring compliance with healthcare regulations? If so, we have an exciting opportunity for you to join us at the Albert J. Solnit Children's Center – South Campus in Middletown, CT.

About the Albert J. Solnit Children's Center – South Campus
The Albert J. Solnit Children's Center – South Campus is a state-administered Psychiatric facility for Connecticut’s children who are under the age of eighteen. Situated on a 67-acre campus in Middletown, CT, the center provides comprehensive care to children and adolescents with severe mental illness and related behavior and emotional problems. Our team is dedicated to helping youth improve their individual and social competencies, ensuring a brighter future for each child.

Benefits

At State of Connecticut, we prioritize the well-being of our employees and recognize the importance of maintaining a harmonious work-life balance. Alongside competitive compensation, we provide a range of benefits, including medical, dental, and vision insurance, retirement plans, paid time off, and professional development opportunities.

Visit our new State Employee Benefits Overview pageThe 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.
Job Responsibilities
Conduct utilization reviews to determine the appropriate level of care and length of stay for patients.Collaborate with interdisciplinary teams to ensure effective and efficient utilization of resources.Develop and implement utilization review protocols and procedures.Ensure adherence to state and federal standards and regulations relating to mental health care.Provide training and education to staff on utilization review processes.Prepare reports, tables, and graphs to analyze data and track performance.

Position Details

Full-time, 40 hours per weekFirst ShiftMonday - Friday8:00 a.m. - 4:30 p.m.Albert J. Solnit Children's Center – South Campus, Middletown, CT
Selection Plan
Please visit our 'Applicant Tips on How to Apply' page or view our tutorial.The minimum experience and training requirements must be met by the close date on the job opening, unless otherwise specified.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. In order to comply with Public Act 21-69, the State of Connecticut is no longer asking for resumes during the initial application 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.  Applicants must meet the minimum qualifications as indicated to apply for this position. Should you have questions pertaining to this recruitment, please contact Liz Pinette at elizabeth.pinette@ct.gov.This position will be filled in accordance with contractual language, reemployment, SEBAC, transfer, promotion and merit employment rules.The immediate vacancy is listed above, however, applications to this recruitment may be used for future vacancies in this job class.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 DAS.SHRM@ct.gov.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.Read through this helpful link to prepare for your interview.
PURPOSE OF JOB CLASS (NATURE OF WORK)
In a state agency this class is accountable for a full range of duties involving the assessment and review of health care delivery systems or medical cost containment activities and programs related to agency efforts to promote cost effective quality of care of cost containment in accordance with various federal and/or state statutes, regulations and guidelines.
EXAMPLES OF DUTIES
Performs a variety of duties related to review of various types of health and medical care delivery and reimbursement systems; Participates in utilization review and/or quality assurance programs; Conducts various types of case reviews for quality and appropriate medical management, cost containment, peer review and rehabilitation; Summarizes and analyzes data;Prepares statistical reports; Implements decisions in program according to revisions in standards; Attends professional workshops, seminars and in-service training; Maintains up to date knowledge of all changes in relevant discipline; Monitors personal injuries and medical costs to evaluate need for services billed for appropriate injuries; May monitor agency and third party administrator files to oversee contractor handling; May review medical records of various health care eligibility, resource unit referral and/or compliance with federal funding provisions; Performs related duties are required.
KNOWLEDGE, SKILL AND ABILITY
Considerable knowledge of principles, practices and current trends in nursing; Knowledge of and ability to apply relevant state and federal laws, statutes and regulations; standards of practice of medicine and nursing as well as other health care disciplines; regulations and standards pertaining to utilization review; care and service delivery to injured workers; Skills interpersonal skills; oral and written communication skills; Ability to analyze patient profile and progress charts to evaluate proper care and treatment.
MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE
Three (3) years of experience as a Registered Professional Nurse.
MINIMUM QUALIFICATIONS - SPECIAL EXPERIENCE
One (1) year of the General Experience must have been in hospital or institutional nursing, in a medical treatment facility, in rehabilitative or occupational nursing or providing medical review of insurance claims.
MINIMUM QUALIFICATIONS - SUBSTITUTIONS ALLOWED
A Bachelor's degree in nursing may be substituted for one (1) year of the General Experience.
PREFERRED QUALIFICATIONS
Experience providing quality assurance specifically, writing reports, creating tables and graphs, analyzing data and performance improvement protocols. Experience with Microsoft Excel and data reporting.Experience conducting quality audits for compliance to regulations.Experience with training and educating staff.Experience with State and Federal behavioral health standards and regulations, including, but not limited to: The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS), Department of Public Health (DPH).
SPECIAL REQUIREMENTS
Incumbents in this class must possess and retain a license as a Registered Professional Nurse in Connecticut.Incumbents in this class may be required to travel.
Conclusion
AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER

The State of Connecticut is an equal opportunity/affirmative action employer and strongly encourages the applications of women, minorities, and persons with disabilities.
ACKNOWLEDGEMENT
As defined by Sec. 5-196 of the Connecticut General Statutes, a job class is a position or group of positions that share general characteristics and are categorized under a single title for administrative purposes.  As such, a job class is not meant to be all-inclusive of every task and/or responsibility.

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