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Nurse Coordinator for Utilization Review

2 months ago

Middletown, Connecticut, United States State of Connecticut Full time
About the Role

We are seeking a highly skilled and experienced Utilization Review Nurse Coordinator to join our team at the State of Connecticut. As a key member of our healthcare team, you will play a critical role in ensuring the delivery of high-quality care while promoting efficient utilization of available services.

Key Responsibilities
  • Coordinate workflow and determine priorities to ensure the delivery of high-quality care with efficient utilization of available services.
  • Schedule, assign, oversee, and review work to ensure compliance with relevant federal and state laws, regulations, and standards.
  • Establish and maintain program protocols and procedures to ensure effective care delivery.
  • Provide staff training and assistance to ensure a high level of care and service delivery.
  • Act as a liaison with other operating units, agencies, and outside officials regarding program policies and procedures.
  • Prepare reports and correspondence to ensure accurate documentation and communication.
  • Assess, evaluate, and monitor documentation of all hospital disciplines when performing case reviews.
  • Attend professional workshops, seminars, and in-service training to stay up-to-date on industry developments and best practices.
Requirements
  • Five (5) years of experience as a registered professional nurse.
  • Two (2) years of experience 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.
Preferred Qualifications
  • Experience with Data Collection, analysis, and presentation.
  • Intermediate to advanced skills in creating spreadsheets and utilizing data to create charts and graphs.
  • Experience with the Joint Commission's accreditation standards for hospital.
  • 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.