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Utilization Review Nurse Coordinator

3 months ago

Middletown, United States State of Connecticut Full time

Introduction

Are looking for your next step in healthcare? Do you have experience processing Minimum Data sheets for a Skilled Nursing Facility? If so, the Albert J. Solnit Children’s Center is looking for you to be part of their team The , Department of Children and Families () seeks a qualified individual for a full-time position within the , located at 915 River Road, Middletown CT 06457. Position Highlights: Full-time, 40 hours per week First (1st) shift Monday - Friday 8:00 a.m. - 4:30 p.m. Middletown, CT About Us: is a state-administered Psychiatric facility for Connecticut’s children who are under the age of eighteen. The Solnit Center provides comprehensive care to children and adolescents with severe mental illness and related behavioral and emotional problems who cannot be safely assessed or treated in a less restrictive setting. The South Campus consists of four coed hospital units and three female adolescent psychiatric residential treatment facility cottages (PRTF). What’s In It For You: Visit our new page To work for a Forbes top company: ‘ Forbes ’ - State of CT Receives National Recognition for Offering Job Growth, Competitive Benefits, and Flexible Schedule; Professional growth and paid professional development opportunities. A healthy to all employees. State of Connecticut is an eligible Public Service Loan Forgiveness employer, meaning you may be eligible to have qualifying student loan forgiveness after 10 years of service. Click for more information. Discover the opportunity to:  Engage in a rewarding career Assist our employees so they can achieve success Make a difference in the public sector Work together in a collaborative team environment

Selection Plan

FOR THOSE WHO HOLD A RN LICENSE IN A STATE OTHER THAN CONNECTICUT AND WISH TO APPLY FOR A CONNECTICUT LICENSE, PLEASE: Review the eligibility and documentation requirements for CT license by endorsement of an out-of-state license;Complete a CT DPH online application online (expand the ‘Public Health Practitioners’ grouping, select ‘Registered Nurse’ and then ‘Start’;Request verification of your out-of-state license(s) electronically through the National Council of State Boards of Nursing’s : Nursys® System. To send verification of your license(s) to CT, read and agree to the terms, enter your biographic information, select your license type and select ‘SEARCH’. Review the results and select the ‘Next’ button. Check the box next to ‘Connecticut’ and complete the transaction. Once the transaction is completed, you will receive a confirmation email from Nursys and the verification will be available to the DPH. Note that PA and MI verifications are not provided through Nursys. Please contact those state boards for information on obtaining verification. For Assistance in Applying: Please or our Applicant Tips on How to Apply Application Process: This position will be filled in accordance with contractual language, reemployment, SEBAC, transfer, promotion and merit employment rules. For current state employees, salary calculations are not necessarily comparable from branch to branch but it does not impact your state service credit. In order to comply with Public Act 21-69, the State of Connecticut is no longer asking for resumes during the initial application process. In order to be considered for this job opening, you must meet the minimum qualifications as listed on the job opening. You must specify your qualifications on your application. The minimum experience and training requirements must be met by the close date, unless otherwise specified. 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 . Please ensure that your application is complete. You will be unable to make revisions once you officially submit your application to the state of Connecticut. Selection Process: This posting may require completion of additional referral questions (RQs) which will be sent to you via email after the closing date. The email notification will include an expiration date by which you must submit (Finish) your responses. Please regularly check your email for notifications. Please check your SPAM and/or Junk folders, as emails could end up there in error. During the recruitment process, applicants may be required to submit additional documentation supporting their qualification(s) for this position. These documents may include performance reviews, supervisory references, college transcripts, licensure, etc. at the discretion of the agency. Read through this helpful link to . Contact Information: Due to the large volume of applications received, we are unable to provide confirmation of receipt or status during the recruitment process. Should you have any questions pertaining to this recruitment, please contact Christopher Lavallee at .

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. ADVANCED WORKING LEVEL (INVESTIGATORY):
Conducts complex investigations into allegations of abuse or neglect of individuals with an intellectual disability; Conducts complex investigations into cases where a death has resulted of an individual with an intellectual disability for whom the Department of Developmental Services has direct or oversight responsibility for medical care; Reviews medical care that was provided to individuals; Assists in the investigation to determine if the death is a result of abuse or neglect; Participates in the reviews of events, overall care, quality of life and medical care preceding a death; Works cooperatively with State and local police, State's Attorneys and other protective services organizations; Interviews alleged victims, direct care providers, families and other potential witnesses; Prepares comprehensive, complex investigative reports; Maintains records and documentation; Reviews medical records for pertinent information related to investigations; May provide information and assistance to the Independent Mortality Review Board or Fatality Review Board for Persons with Disabilities; May testify in court proceeding; Performs related duties as required. DEPARTMENT OF VETERANS AFFAIRS:
Coordinates activities of care team, plans and schedules meetings, tracks input and attendance; Ensures outcome of process is accurate document for care planning; Audits process according to utilization guidelines and ensures process is completed within appropriate regulatory time frames; Trains all Health Care Team members on Resident Assessment Instrument (RAI) care planning system; Acts as resource to all areas involved in Minimum Data Set (MDS) process; Ensures compliance with state statutes, federal Veterans Affairs regulations and state Department of Veterans Affairs policies and procedures; Monitors and manages timely electronic transmission of MDS program data; Routinely conducts chart audits and maintains log of deficiencies and discrepancies; Identifies errors in coding of MDS and RAI forms during completion process; Communicates to leadership and interdisciplinary team members any changes to directives and guidelines; Enters MDS data into information system; Assures ongoing record documentation supports MDS and RAI coding; Develops plan of action to correct identified quality deficiencies; 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 with Data collection, analysis, and presentation. Experience with Medicare & Medicaid Regulatory requirements and private insurances as it relates to utilization review/management and quality of care. 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.

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.

Overview

Employee Benefits As a State of Connecticut employee you may be entitled to a host of benefits that are not only attractive, but also may be portable should your career bring you to other avenues of state service. From 13 paid holidays to accruing vacation time, being a State of Connecticut employee not only gives you the opportunity to make a difference in someone’s life, but the time to enjoy your own. Listed below are just some of the benefits the State of Connecticut offers depending on the position you hold: Health & Dental Insurance Accrued Vacation, Personal and Sick Leave (Subject to the appropriate bargaining union contract or state statute and regulations.) Retirement Plan Group Life Insurance Supplemental Benefits Voluntary Defined Contribution Plans Flexible Spending Accounts (Dependent Care Program, Medical Flexible Spending, and Qualified Transportation) Supplemental Benefits Programs (Auto and Home Insurance, plus Short and Long Term Disability) Life Insurance State of CT Tuition Reimbursement Program Holidays