Utilization Review Nurse

Introduction

Are you aRegistered Nurselooking for an opportunity to make a difference in the public sector? If so, read below and apply today TheState of Connecticut,Department of Mental Health and Addiction Services (DMHAS) is seeking a highly motivated and compassionateUtilization Review Nurseto join our team POSITION HIGHLIGHTS SCHEDULE:Full-Time (40 Hours), First Shift (8:30 A.M. - 5:00 P.M.), Monday - Friday FACILITY:Connecticut Mental Health Center (CMHC) TEAM:Administration Team ADDRESS:34 Park Street, New Haven POSITION NUMBER:26760 WHAT'S IN IT FOR YOU: Visit ournewState Employee Benefits Overviewpage Professional growth and development opportunities A healthywork/life balance Work at a Forbes-recognized company Connecticut is proud to be featured on both America's Best Employers by State and Best Employers for New Grads in 2024. With our dynamic job market and commitment to fostering a thriving workforce, Connecticut stands out as a top destination for both seasoned professionals and fresh graduates seeking to launch their careers DISCOVER THE OPPORTUNITY TO: Communicate with patients regarding their entitlements (Medicare/Medicaid, private insurance) and ensure all relevant paperwork is signed; Work with Dept. of Administrative Services billing to ensure maximum revenue for inpatient stays; Monitor length of stay and work with treatment teams on discharge planning; Complete continuous audits/tracers of inpatient documentation in support of Joint Commission standards; and Attend treatment team meetings and provide feedback on level of care, discharge planning, etc. ABOUT US: DMHAS is a health care agency whose mission is to promote the overall health and wellness of persons withbehavioral 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. CMHC is an urban community mental health center with an exceptional 50-year tradition of serving individuals with serious mental illness and/or addiction. Founded in 1966, CMHC is a partnership between DHMAS and the Yale Department of Psychiatry. Each year over 4,000 people receive a variety of recovery-oriented services at CMHC and its satellite clinics. CMHC is nationally recognized for its scientific research into the causes and treatment of mental illness and addiction. The Abraham Ribicoff Research Facilities include multiple research programs in a variety of areas. CMHC is also a major training site for individuals pursuing careers in mental health fields including psychiatry, psychology, social work, nursing, and pastoral care. Please note: A comprehensive medical examination, including a drug screening, will be required of all applicants upon a conditional offer of employment. All state employees must adhere toConnecticuts Policy for a Drug Free Workplace. Start with us. Stay with us. Grow with us.

Selection Plan

FOR ASSISTANCE IN APPLYING: Check out ourApplicant Tips on How to Apply Need more resources? Visit ourApplicant Reference Libraryfor additional support throughout the recruitment process. FOR THOSE WHO HOLD AN 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 Nursings : 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. 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. BEFORE YOU APPLY: Meet Minimum Qualifications:Ensure you meet the Minimum Qualifications listed on the job opening by the job closing date. You must specify your qualifications on your application. The minimum experience and training requirements listed must be met by the close date on the job opening, unless otherwise specified. Educational Credits:List your earned credits and degrees from accredited institutions accurately on your application. To receive educational credits towards qualification, 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 contact listed below. Resume Policy:PerPublic Act 21-69, resumes are not accepted during the initial application process. As the recruitment process progresses, candidates may be required to submit additional documentation to support their qualification(s) for this position. This documentation may include: a cover letter, resume, transcripts, diplomas, performance reviews, attendance records, supervisory references, licensure, etc., at the request and discretion of the hiring agency. Preferred Shift/Location:Select all location(s) and shift(s) you are willing to work on your application. Failure to do so may result in not being considered for vacancies in that specific location or shift. Timely Submission:All application materials must be received by the job posting deadline. You will be unable to make revisions once you officially submit your application to the State. Late submissions are rarely accepted, with exceptions only for documented events that incapacitate individuals during the entire duration of the job posting. Request exceptions by emailingDAS.SHRM@ct.gov. Salary Calculations: 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. Note: Theonly wayto apply to this posting is via the Apply or Apply Online buttons on the official State of Connecticut Online Employment Center job posting. AFTER YOU APPLY: Referral Questions:This posting may require completion of additional Referral Questions (RQs), which must be completed by the questionnaires expiration date. If requested, RQs can be accessed via an email sent to you after the job close date or by visiting your JobAps Personal Status Board (Certification Questionnaires section). Prepare For An Interview:Interviews are limited to those whose experience and training are most aligned with the role. To prepare, review this helpfulInterview Preparation Guideto make the best impression Stay connected Log in daily to your JobAps Personal Status Board to track your status and check email (including spam/junk folders) for updates and tasks. The immediate vacancy is listed above, however, applications to this recruitment may be used for future vacancies in this job class. Note: This position will be filled in accordance with contractual language, reemployment, SEBAC, transfer, promotion and merit employment rules. 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, available atwww.ct.gov/ethics. QUESTIONS? WERE HERE TO HELP: Due to high volume, we are unable to confirm receipt or provide status updates directly. For recruitment updates, please check your Personal Status Board and review our Frequently Asked Questions. If you have additional questions about the recruitment process, reach out to Nicole Frascatore viaNicole.Frascatore@ct.gov. Join the State of Connecticut and take your next career step with confidence

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 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 with inpatient psychiatric hospitalization and discharge focused treatment planning. Experience with Medicare Part B billing requirements. Experience with Medicare/Medicaid and commercial insurances (authorizations, billable services, level of care criteria). Experience participating within a multidisciplinary treatment team. Experience teaching and providing guidance to providers on how to improve the level of quality in their documentation. Experience with Excel, Word and other programs to collect, analyze and report data.

SPECIAL REQUIREMENTS

Incumbents in this class must possess and retain a license as a Registered 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.