Introduction
The Department of Mental Health and Addiction Services seeks qualified individuals for the position of Utilization Review Nurse (DMHAS), within the Western Connecticut Mental Health Network, POSITION #25022. LOCATION: 55 West Main Street , Suite 410, Waterbury, CT, 06702-5501. This is a full-time forty (40) hours per week position. The work schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m. Travel will be required to work locations in Waterbury, Torrington, and Danbury.
The selected candidate will assess regulatory compliance and conduct medical record case reviews for quality and appropriate care to ensure proper documentation, service collection, and billing.
Should you have questions pertaining to this recruitment, please contact Julie Roy, Julie.Roy@ct.gov or (203) 805-6407.
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 inservice training; maintains up to date knowledge of all changes in relevant discipline; may monitor agency and third party administrator files to oversee contractor handling; monitors personal injuries and medical costs to evaluate need for services billed for appropriate injuries; 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; knowledge of standards of practice of medicine and nursing as well as other health care disciplines; knowledge of regulations and standards pertaining to utilization review; knowledge of care and service delivery to injured workers; 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 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.
SPECIAL REQUIREMENTS
1. Incumbents in this class must possess and retain a license as a registered professional nurse in Connecticut.
2. Incumbents in this class will 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.
