State of Connecticut Executive Branch

Utilization Review Nurse (35 Hour) (5612HC)

$36.68-$49.71 Hourly / $2,566.90-$3,479.09 BiWeekly /
$66,996.00-$90,804.00 Yearly

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.

SUPERVISION RECEIVED

Works under the general supervision of a Utilization Review Nurse Coordinator, Nurse Consultant or other employee of a higher grade.

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.

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.

JOB CLASS DESIGNATION

Classified/Non-Competitive

OCCUPATIONAL GROUP

(22)-Nursing

BARGAINING UNIT

(11)-HEALTH PROF (P-1)

EEO

(2)-Professional

SALARY INFORMATION

HC 23

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.

CANCELLATION CLAUSE

This replaces the existing specification for the class of Utilization Review Nurse (35 Hour) in Salary Group HC 23 approved effective July 7, 1995. (Revised to modernize format and add Acknowledgement section) Final No. 23-244

EFFECTIVE DATE

09/14/2023
CLASS: 5612HC; EST: 5/20/1977; REV: 9/15/2023;